Some dilemmas in health care policy

Neither patients nor physicians are doing a great deal about growing costs, improving the rationality of medical services, or asking hard questions about the value of existing patterns. They have little incentive to do so, and when they do, it is with the clear awareness of their own economic interest. If budgetary cuts have to be made, they inevitably occur at the points of least political resistance-the poor, the old, and the chronically ill. The "middle course" of government intervention-between the harsh realities of a private medical marketplace and the bureaucratic consequences of a rationally planned system of care-has been a costly and inefficient regulatory muddle. Constructive compromises in future policy will be complicated and fiercely political.