The perpetual health care crisis; there may be no public policy solution to health care.

• Author: Doherty, Brian
• Position: Lives at Risk: Single-Payer National Health Insurance Around the World - Miracle Cure: How to Solve America's Health Care Crisis and Why Canada Isn't the Answer - Book Review

Lives at Risk: Single-Payer National Health Insurance Around the World, by John C. Goodman, Gerald L. Musgrave, and Devon M. Herrick, Lanham, Md. : Rowan & Littlefield, 263 pages, $22.95

Miracle Cure: How to Solve America's Health Care Crisis and Why Canada Isn't the Answer, by Sally C. Pipes, San Francisco: Pacific Research Institute, 219 pages, $14.95

Science writer Gregg Easterbrook once waxed perplexed over Americans' anger with managed-care Health Maintenance Organizations. "It's one thing for the public to loathe an industry whose performance is declining" he mused, "but the health care business is losing stature at a time when its performance is improving. By almost all measures, U.S. public health gets better every year. Americans are living longer than ever before, and heart disease, stroke, hypertension, AIDS, and most forms of cancer are steadily declining."

Easterbrook suffered from a category error that infects many other eggheads contemplating the hideous tangles of our highly regulated health care system: the conflation of health care with health. Health care becomes vital only for people who aren't healthy. Contemplate Easterbrook's list of things that doctors and hospitals don't prevent but only try (often ineffectually) to cope with after they strike. Generally speaking, the more health care you consume, the less healthy you are. The biggest consumers of health care tend to be people in their dying days, tenaciously and heroically holding on to life, but by no normal standards "healthy."

The same dynamic applies to the relation between our consumption of health care systems--the use of governments and other big institutions to manage and manipulate the provision of medical care and health insurance--and the health and wealth of our polity.

Lives At Risk: Single-Payer National Health Insurance Around the World, by John C. Goodman, Gerald L. Musgrave, and Devon M. Herrick (all associated with the National Center for Policy Analysis, a Dallas-based think tank), and Miracle Cure: How to Solve America's Health Care Crisis and Why Canada Isn't The Answer, by Sally C. Pipes (who heads the Pacific Research Institute, a San Francisco-based think tank), limn the barriers to the pursuit of fiscal (and sometimes actual) health created by enormous and complicated health care systems. Both provide ammunition for one side in a policy war that is still raging more than a decade after the failure of ClintonCare. It's the war over whether American health care policy should march toward markets, choice, and individual control and responsibility, or deeper into the territory of top-down rationing, price controls, mandatory coverage and payments, and myriad other restrictions on how we buy and sell health care services and insurance.

The books are mostly devoted to positively comparing the American system (while recognizing its many flaws, most of them regulation-related)...