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America's Health in the Balance: Choice or Chance?

America's Health in the Balance

In America's Health in the Balance, Howard Hiatt deftly moves back and forth between the doctor-patient relationship and the health care system in general. Physicians, he says, must often ration the care they give. That is the result of the lack of adequate policies for a fair allocation of resources and a public failure to acknowledge the existence of a problem. By default, not policy design, physicians are left to cope as best they can. Constant technological developments and increasing numbers of the elderly work to raise costs in so far uncontrolled ways. Great Britain and Canada (particularly the latter) face the same kinds of pressures but, in contrast to this country, have policies that have kept their costs much lower yet with health outcomes as good as ours.

Canadian health economist Robert G. Evans has tireless argued a similar point, noting that an important diffeence between Canada and the United States is that the former has been willing to impose government controls in a way this country never has. Those controls restrain costs but they do not ruin good health care. That is important to bear in mind because the kinds of reforms that Dr. Hiatt calls for would all require a strong governmental hand: meeting basic needs through some form of national health insurance, and rigorous programs of preventive medicine, biomedical research, technology assessment, expanded use of pilot studies, and systematic evaluation of experimental programs.
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Author:Callahan, Daniel
Publication:The Hastings Center Report
Article Type:Book Review
Date:Apr 1, 1988
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