In a survival economy (where substantial numbers are dying for lack of food) much health care is deemed a privilege. Certainly it doesn't make sense to spend large sums to prolong the lives of terminally ill patients when babies are starving for lack of only a few cents. In an affluent economy, though, people regard availability of virtually all effective health care as their right. It does not seem appropriate for anyone to suffer or die for lack of care when both private and public funds abound.

So for many years the health care system had one mandate from the public: Give us the best. And the best became more and more expensive. Medical advances were often costly: CAT (Computerized Automated Tomography) scans and MRI (Magnetic Resonance Imagery) scans used equipment costing millions. Life support systems kept people alive for weeks or months at huge expense...