From Health Care to Discrimination

As we try to improve our lives with a national health care plan we must not forget the "law of unintended consequences" to which Robert Merton alerted us in 1936. Two examples illustrate the danger. Few people foresaw that federal support for poor mothers with dependent children would contribute to the breakup of black families, but it did. Nor did people foresee that rent control would contribute to the trashing of cities, but it did.

With those failures in mind, what can we say about the possible unintended consequences of well-intended health care legislation? I suggest that one of the most important consequences will be this: we will be forced to reexamine the word "discrimination" and the actions that result from it. Lest I be misunderstood, let me say that the attack on race discrimination made in the 60's was by no means a mistake. Far from it. But the condemnation of discrimination has extended far beyond that early application. A national health care system can succeed only if discrimination—appropriate, defensible discrimination—is made an integral part of it.

The need for discrimination is most apparent in the application of medicine to the far end of life. Medicine has not "conquered death," nor does it seem either desirable or likely that it ever will. But modern medicine has certainly postponed our deaths and increased their costs. Even worse, delaying mortality...

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