Academic journal article The Hastings Center Report

Imaginary Trees

Academic journal article The Hastings Center Report

Imaginary Trees

Article excerpt

"Alternatives, and particularly desirable alternatives, grow only on imaginary trees . . ." The Dutch government committee document Choices in Health Care takes its epigraph from Saul Bellow's Dangling Man and tries to imagine an alternative to the prevailing Dutch view that everyone has the right to all possible medical treatments, regardless of price. It tries to imagine a health care system in which, with a view to the good of the whole, choices are made that limit the access of some individuals to some kinds of treatment.

In the face of rising costs, increasing technological options, and an aging population, the committee thinks that there are three logically possible ways to reduce the pressures on its health care system. The first way is to make more money available to health care by increasing revenues; the second to save money by increasing efficiency; and the third to make explicit choices about and set limits on care. The committee finds, however, that because increased revenues for health care will not be forthcoming and increased efficiency, while good, is not sufficient significantly to reduce pressures on the system, attention must be turned to painful choices.

How, then, does the committee propose to make such choices? Though its invocation of Saul Bellow and its appeal to solidarity as its fundamental value sound alien to an ear attuned to American government documents, the Choices in Health Care committee's recommendations for dealing with health care questions sound strikingly familiar. Indeed, the report advocates a plan much like Oregon's.

The committee urges that in articulating the basic package to which all citizens are entitled, the Oregon procedures be followed. …

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