we had conquered infectious diseases." Advances in medicine, then, accompanied by cost increases of medical care, are set beside relatively limited access to care, creating a system of "rationing" of specific treatments "through market mechanisms . . . determined by such factors as how much money one has or how close one lives to a major health-care center. Power and celebrity can also play a role."
Government-funded health care is currently available chiefly through two cost-subsidy programs: Medicare and/or Medicaid, the former a federal program available to elderly Social Security recipients and the latter a federal-state cooperative program for indigent patients. Persons earning $18,000 a year are ineligible for Medicaid; about 40 million persons (15 percent of the population) have no medical coverage. Health care is also financed and/or subsidized in the private sector by means of employer-provided health insurance. Controversy surrounds publicly funded health care, which is said to be lacking in efficiency or fairness or both. Those in favor of mandating U.S. government health care for all citizens seek to expand medical care to younger as well as older patients, to the middle class as well as the poor.
An expanded government role in health care implies expan ded taxes, but advocates and opponents of government-sponsored care are sharply divided on how costs should be accounted for. As a practical and logical matter, it is impossible for the government to provide health care to all citizens without its costing somebody something. An additional problem, outside the scope of this research, is whether the government can or should provide care to noncitizens as well as citizens--and who should pay for that. Estimating the a
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