Budgetary Medical Ethics

Abstract

TNevertheless, we need to be rejuvenated on occasion by recalling that the majority of the increase in life expece 9 tancy this century has resulted from basic prevention cc.A programs. We need to be reminded that the terror of smallpox is unknown to this generation of Americans; that parents are spared worrying about children mentally retarded by measles and crippled by polio. We have traveled far from the days of our grandparents, when the joys of parenthood were interrupted by diphtheria and pertussis, when young marriages were ended by tuberculosis and communities were shattered by cholera. For this we can thank prevention. Recent decades have seen the rapid delineation of risks which can be altered by individual behavior and the widespread dissemination of that information. Recent responses, including a decrease in smoking rates, state laws requiring child restraints in automobiles, the raising of drinking ages in some states, and increased attention to drinking and driving laws, provide hope that prevention efforts will continue to improve. The concern for worker health, the systematic examination of risks in the workplace, recommendations on allowable exposure levels to physical and chemical agents are tributes to public health attempts to improve the quality of existence both for this generation and for those to follow. Despite the obvious positive contributions of public health, we are confronted with a basic contradiction, namely the continuing increase in health care expenditures while prevention advocates are forced to fight repeatedly for already proven programs. This contradiction is highlighted fifty to sixty times each week as another preventable death from tubercu-