And I'd say that this is the best way I can think of to address the growing health care crisis that we face-as we face, for instance, the fact that we are paying the highest per capita cost in the industrialized world to care for our sickest, most fragile patients with the highest rates of illness. The solution is not to try to control our way of thinking about health care. It is to try to make better choices about care. The fact that it's not going to happen any time soon will not diminish its implications-it is going to shape our political climate. There is no other nation in the world that can say that. After all-and I've said it many times-what we want to be is not a socialist/communist government, but a society in which everyone is treated fairly. We cannot have a government that has a monopoly on the right to choose and then forces its citizens to choose between the two alternatives.

Perhaps it is time the American people took a hard look in the mirror at the kind of care they are receiving, and asked themselves how much better they would be receiving it, if they were allowed to pick the type of care they wished for. The fact is, the average American gets about the same medical care they have had for decades. And the best medical care is available in the private sector. But even as private health insurance companies become more and more common, private insurers remain the best-protected and most widely used sources of coverage. And when the government expands health care to more people, private insurers will be the best-protected and easiest to reach, especially for a relatively small number of people like myself in whom health care coverage is very rare and complicated. I want to stress that I am not trying to argue that people who want better medical service are wrong to do so. I am simply saying-as I do on this page and elsewhere-that it is not always possible to get the best possible service at a reasonable price, particularly when the government is involved.

The problem may not be the cost of medical care per se but how the costs of treating the patients are calculated and shared. And I am convinced that there are many people, in the American medical system and others, who believe this, and are right about its consequences. So please ethionamide take it personally if I don't agree or even suggest that your personal situation is one of these. The American public has already been made aware that some of what they receive from the private sector is better than that which they received from the public sector in the past. Americans have been made aware that Medicare is far less expensive than private insurance and that they should not expect their doctors to be able to treat them with any more money than they did in the past.

There is a certain irony in the fact that the American public has been made aware for almost 50 years that their government is less effective than their private-sector counterparts. But this is an uncomfortable fact for many Americans because the American public has been made aware that many of its private-sector counterparts are not even as effective as their government counterparts. For example, the government is not very effective at preventing people from losing their jobs because of a disability, or at providing adequate care for the ill and dying, or at preventing drug addiction or mental illness, or at preventing suicide. All the public-private and government-private programs do are to some extent ineffective. In fact, if you look at a map of America you will see that, contrary to what many people think, there is more federal control of America's health care than any other country in the world. The only reason why the public does not understand that we have a far better system than they have is because many people think it is impossible.


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