PEDIATRICS Vol. 55 No. 6 June 1975, pp. 817
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A NATIONAL HEALTH PROGRAM: ORGANIZED DIVERSITY

P. Starr

The pivotal long-range question in medical reform is whether medicine should be viewed as a technical activity with occasional moral or social overtones or, alternatively, as a social and moral activity with a technical substratum. Is . . . medical care . . .more like the supply of water or the provision of education?

If medical care is ultimately a technical activity like water supply, its management can be safely entrusted to experts in the field.

If, on the other hand, medical care is primarily a moral and social activity like education, the situation is quite different . . . . Consequently, in organizing our institutions, we have good reason to provide for both participation and diversity. We may also wish to sacrifice some of the "efficiency" of a single, professionally run system for the relative inefficiency of variegated institutions sometimes in conflict with one another.

In the system advocated . . . the government would pay the basic annual cost, although families would choose to spend more for additional services.

What I am proposing here is an organized system that uses competition in a premeditated fashion: competition under constraint.