In every rich country, it seems, people expect too much of their health-care systems. That is why, in their different ways, they are disappointed—and why they always will be. Citizens everywhere desire unrestricted access to state-of-the-art technologies. Increasingly, they insist on choice and control, too. Yet they are unwilling to pay what those things cost. People demand as a right the best health care money can buy, delivered in the way that best suits them, expense be damned. All that, and the price must be affordable.
Nowhere can this self-contradictory demand be satisfied. Everywhere, therefore, health care presents itself to governments as their most difficult nonsecurity challenge. In the United States, the costs are already staggering, and unless something changes, they will only get worse. Such is the sensitivity, though, that only the bravest or most reckless policy makers stride up to the issue with a genuine intention to act. Health care is a political death trap.
Consider this: the government increases its spending on Medicare by tens of billions of dollars a year (as the administration did with its recent prescription-drug reform) and the beneficiaries are up in arms about it. Yes, the execution of the scheme was botched. Still, where else could generosity on such a scale actually arouse hostility, to say nothing of its apparent failure to buy votes? When Americans are asked what they think about health care, most say they like the quality of service (the government must do nothing to compromise those high standards); they also complain that health care is far too costly (the government must act).