How Much Is Enough?
Medicine is a science of uncertainty, and an art of probability.
Sir William Osier
Just as What is care? was, in Flood's terms, an inquiry into health care's effectiveness, How much is enough? is an inquiry into health care's efficiency. In systems language, enough is shorthand for the amounts of resources, or inputs, the health care system uses to produce its output— health. Efficiency is asking whether the right amount of resources flow to the right recipients at the right time to achieve what is best for the nation's health. In short, efficiency refers to not wasting resources.
Questions of enough are questions of finitude; they implicitly assume there are limits to life as well as to resources. Enough indicates rationing, and rationing, which also refers to not wasting resources, implies limits to longevity, to health care's ability to cure, to technology's beneficence, and to the profits stakeholders can make. Questions of enough are complex, confusing, and emotionally charged because our answers to How much is enough? will (1) affect each system in the nested hierarchy of systems, and (2) affect all of health care's stakeholders, albeit differently.
Inquiry is like rock climbing in that the next move depends upon the present position. Moving through thought, so to speak, our answers to How much is enough? largely depend upon what we have learned from our inquiry into What is health? and What is care? Because our inquiry is actually a search for coherence, it follows that our answers to How much is enough? should balance with our answers to What is health? and What is care? We are searching for information that will, in Flood's terms, generate an effective, efficient, and fair health care system.