group of mostly poor people, enough to comprise a large state,rndesperate and unable to obtain basic medical care. In fact, thernBureau of the Census estimates arc an average in a givenrnmonth. A 1992 report put out bv the bureau estimated that inrn1987 only about 16 million people were without insurance forrnall of 1987. Now this is still a large figure, but it is not as shockingrnas Clinton would have us believe.rnMoreover, health insurance status is constantly changing,rnand the uninsured population is not always the same group ofrnpeople. Most spells of uninsurance last only a few months, andrnmost of the uninsured are young and generally healthy. Manyrnof them are not destitute and could even afford insurance ifrnthcv wanted it. According to Congressional Quarterly, about 10rnpercent of the “uninsured in 1991—neady 4 million people—rnhad family incomes in excess of $50,000 a ear.”rnClinton and other supporters of compulsory national healthrninsurance convey the impression that the uninsured have norn”access” to health care and that therefore our health care systemrnis “broken.” In fact, the uninsured—even illegal aliens—rndo ha e “access” to health care, albeit in inefficient ways. Thernproblem is that they do not have someone else to pay for theirrncare. Federal law requires that all hospitals provide screeningrnand treatment “if any individual . . . comes to the emergencyrndepartment and a request is made on the individual’s behalf forrnexamination or treatment of a medical condition.” This is notrna desirable process for either hospital or patient. According tornthe I leaith Care Financing Administration, uncompensatedrncare provided by hospitals totaled $17.8 billion in 1990. Adjustedrnto reflect actual losses rather than total unpaid charges,rnhowcNcr, the figure was $11.7 billion, or about six percent ofrnnet patient revenue. Once again, this is a problem that needsrncorrecting but not at the price set by Clinton.rnThe amount of money the United States spends on healthrncare is another indicator, according to the critics, that somethingrnis terribly wrong. The two most important measures arernaggregate spending and spending as a percent of Cross DomesticrnProduct. Clinton and others see in these data portentsrnof doom. Thev see signs that costs arc “skyrocketing” and thatrnthe svstem is “collapsing.” Moreover, thev believe that healthrncare spending inhibits us from spending more on socially usefulrnenterprises.rnIt is true that the United States spends more money in thernaggregate and as a percent of GDP on health care than anyrnofher country in the worid. This does not mean that wc havernthe “costliest and most wasteful system on the face of thernFarth,” as Clinton charged in September, or that we are facingrna national calamity, as the President has also indicated. We dornspend a great deal of money on health care in the UnitedrnStates, but we do so partly because we have been fortunaternenough to be a wealthy society. Wc can afford (or were oncernable to afford) to build and staff the finest hospitals and medicalrnschools in the vodd; to conduct half of the medical andrnpharmaceutical research in the wodd; to save the lives of prematurerninfants weighing barely more than a pound; to keeprnali e ictims of accidents, kidney disease, or cancer who wouldrndie in poorer or more “efficient” countries.rnHealth care spending in the United States is also driven byrnforces beyond the health care system itself, and probably beyondrncontrol of the government. These include an expandingrndefinition of what health means, the effects of criminalrnviolence, and the medical costs associated with divorce, illegitimacy,rndrug use, and sexual behavior. A large, but immeasurable,rnportion of health care expenditures in the UnitedrnStates is the result of the cultural revolution and transformationrnof values that began in the 1960’s.rnSo, if it is true that the United States spends more money onrnhealth care than other countries, what of it? Among the Organizationrnfor Economic Cooperation and Developmentrn(OECD) nations, ‘lurkey spends the smallest percent of GDPrnon health care. Does this mean that Turkey is doing a better jobrnthan the United States? Such a conclusion would be ludicrous.rnWhy, then, does the fact that the United States spends arnhigher percentage of its GDP on health care than other nationsrnmean that our health care system is one of the worst “on thernface of the Earth,” according to Clinton and other critics?rnThere is no “correct” amount to spend. How much we dornspend is a choice we make, just like anv other.rnAlthough we spend a great deal of moncv on health care inrnthis country, we receive much in terms of quality and convenience.rnAmericans do not have to wait months or years forrnroutine services or a hospital bed, as is the ease in Canada orrnGreat Britain. Moreover, we pay our health care workers andrnprofessionals well and receive high quality care in return. Sincernhealth services are labor intensive, it is inevitable that tightrnspending controls will translate into lower wages and fewer jobsrnin the health services sector of the economy. I low this will benefitrnus, Clinton has not explained. When you get down to thernnitty-grittv of how national health care systems achieve “savings,”rnit is through .skimping on wages and qualitv. This is howrnit vill eventually be done in the United States if Washingtonrngains complete control of health care.rn^ ^ linton (as well asrnf •>. Congress) has norny ^ _ y Intention of confrontingrnthe issue of public spending on healthrncare. This would mean tacklingrnentitlements, something no one wantsrnto do. The Clinton ‘solution,’ then, is tornmake health care an entitlementrnfor everybody.rnIn their diagnosis of health care spending, Clinton and othersrnadvocating his plan argue from another premise that is almostrnne’er examined. Essentially, the Clinton position is thatrnhealth care is a social good of lesser value than other socialrngoods. Repeatedly, Clinton and his supporters assert that if wernwere not “wasting” so much money on health care, we could bern”investing” it in other social goods, especially education. Whyrnis this premise valid? Where has it been shown to be the ease?rnWe already have one of the highest levels of spending perrncapita on public education in the wodd, and the result is medi-rn)UNE 1994/25rnrnrn