the future rate of increase, but that is not enough; that simply puts off for a few years the consequences outlined above. The share of GNP devoted to health care is excessive now, and it must be cut.
What follows is not a proposal about specific policies but an analysis of what must be done if health goals are to be attained without sacrificing everything else: why and what, not how. The obstacles in the way of a wise use of health care resources are not the difficulties in deciding what we want, although our wants often conflict with one another. Nor is our main problem ignorance of how to get from where we are to where we want to go. The principal obstacle is the opposition of powerful groups who stand to lose, or fear they may lose, from the radical reorganization of the health care industry needed to safeguard living standards and achieve a more productive use of valuable resources.
I have talked to many people about the issues raised in this book. Some of their ideas, information, and experiences are reflected in it. I should mention my wife, Nancy Thayer, my daughters, Eileen and Jocelyn, and my sister Anna Louisa McCartney, who made substantive contributions as well as providing moral support. Richard Scheffler will be surprised to know that conversations some years ago made a contribution. Mary Ann Baily and Thomas Moore are a continuing source of information and insight. They will not agree with everything I say, and I retain the same right toward them. To repeat a confession I heard many years ago from Walter Buckingham of Georgia Tech, I agree with myself at least 90 percent of the time. But all the facts are never in. On some minor issues my mind could be changed in the future. But not on the major findings and conclusions.