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of sickness of sickness and health . . . and a changed perception of the ends of medicine" (Gaylin 39). Today, cost-based health care, managed care, rationed care are part of the sometimes contentious and emotional American public-policy discourse, not least because between 1970 and 1997 "health-care costs in the United States have risen from six percent of the gross national product to about 14 percent" (Gaylin 41).

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