In order to avert a disaster in health care, difficult allocation and rationing decisions must be made. This will require a continuing emphasis on cost containment, but any resolution of the problem will also necessitate major alterations in the way health care is perceived by Americans. We must replace our haphazard and patchwork means of allocating resources, which is both inequitable and irrational, with a clearcut set of goals and priorities for resource distribution. Although I argue that this will best be accomplished through a shift in emphasis from high-technology, curative medicine to a broad preventive approach, that is an issue that society must decide in its dialogue over goals and priorities. Whatever decisions are made, the trade-offs must be clarified.
A second theme which must be reemphasized here is the need to alter drastically public expectations and demands concerning health care. This, in turn, necessitates a modulation of basic values concerning rights and responsibilities. Although the government has a role to play in educating the public to the problems and in guaranteeing a public forum for dialogue on how to resolve them, government action cannot be successful alone, without accompanying transformations of public expectations and behavior. This chapter describes several of these transformations and analyzes the problems in effecting them within the American value system and health care tradition.