What Is Health?
What is health? is the significant question. As we've seen, the answers to the other three questions—What is care? How much is enough? and Who is responsible?—are derived from our answer to What is health? Moreover, health care's efficiency, effectiveness, and fairness are measured according to the attributes we assign to health.
In our cultural box analogy, What is health? is the load-bearing wall. That Americans have the most expensive health care system in the word but their country ranks thirty-seventh worldwide at keeping people healthy indicates our current definition of health is not able to bear its load. In systems language, we'd say that our current definition of health is inadequate to organize a productive health care system.
But what is health? Words are vehicles for human relationships. Nouns evoke pictures in our heads. To illustrate, the word elephant evokes a different mental image than the word tree. Unlike the words elephant and tree, the word health does not evoke a consistent image in the minds of either the American public or the experts engaged in health care reform. There is no universally accepted definition of health. There simply isn't a gold standard we can point to and say, This is it. Like freedom and justice, health is difficult to define.
The problem with health care reform is that we rush to tinker with health care costs while assuming everyone has the same idea of health in mind. We don't inquire; we simply assume that health means the same to the insurer as it does to the patient, the same to the young as it does to