Disease, mortality, and the promotion of health.

Prologue: In some quarters there always has been the notion that once countries eliminated a backlog of neglect and improved their health standards, the demand for health care services would stabilize. Lord Beveridge, the driving force behind Britain's National Health Service, thought this thirty years ago when his vision became a reality. And the framers of Medicare were generally of this view when they designed that program. But as David Mechanic points out, the notion, that successful medical care will reduce demand is illusory and contrary to experience. Mechanic, university professor and dean of the Faculty of Arts and Sciences, Rutgers University, has been pointing out the shortcomings of the conventional wisdom with incisive rigor for more than a decade. At the Duke University Medical Center Private Sector Conference this year, Mechanic declared: “The issue is how do we reconcile the competing claims for limited dollars” when the economic incentives favor rendering the most sophisticated care. “Bas...