Learning to Say “No”

Public and private expenditures on health care rose from 5 to 11 per cent of the gross national product between 1960 and 1983. Although there is no magic formula for determining a precise limit on what a country can afford to spend for health care, there is a limit. Every dollar spent on health care is a dollar that cannot be spent on something else. No set of expenditures can rise faster than the gross national product forever. At some point, health-care expenditures must slow down to the rate of growth of the gross national product.The United States is . . .