Judge American medicine by the standards its critics prefer—life expectancy and cost per quality-adjusted life year—and it is easy to present a harsh indictment in PowerPoint. We spend more than anyone. We die earlier than the Germans, the Japanese, and a lengthening list of other social democracies. If the purpose of the system were to maximize population health, the American arrangement would be a waste and, given what we pay for it, a catastrophe.
Yet Americans have never asked their doctors to max out their life table. They ask that when a body fails, a competent stranger will answer quickly, without first requiring the patient to justify himself to a committee. What we purchase, at the highest prices on the globe, is not health. It is responsiveness.
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