Ideas, institutions, and resources.

Abstract

�� Simply put, the goals of any health care system in an advanced industrial democracy are threefold and manifest: (1) provide good care to (2) pretty much the whole population (3) without breaking the bank to do so. The corners of this triangle are quality, equity, and cost. While these combined goals may be manifest, they are also manifestly tricky —p erhaps virtually intractable —i n all the societies under investigation here in this issue. As Jean-Pierre Poullier and Simone Sandier summarize for the French case: “health policy objectives are straightforward and widely shared. . . . [But] mismatches between intent and outcomes have been observed throughout; the future holds more unknowns. Broadly speaking, we can identify two general approaches to the seeking of these health care system goals. The first approach, especially evident in the United States, emphasizes the role of private forces, which may or may not be market ones. These forces interact in a fairly free manner over time to end up resulting in a system—de facto rather than by any overarching design. In this system, the role of the government, or state, is relegated to the margins, a minor referee guarding against some but not all outrageous inequities, perhaps ineffectually coaxing some parties along. Ideologically, in this system, health care is not a “right” or a “due,” but rather a private good, to be obtained according to the individual’s means. The goals-oriented result of such a system has been to (1) provide lots of extremely top-quality care (“rescue medicine”) to (2) only segments of the population, leaving behind other large swathes, while (3) spending