chapter  13
26 Pages

What Can We Get from Effluent Charges?


TA he United States may now be approaching one of those slick, downward-sloping surfaces we so frequently create by our all-ornothing approach to gratifying our shifting enthusiasms. For ex­ ample, a little over a decade ago we decided it was unconscionable that elderly people with fixed incomes and poor people with virtually no incomes should face the possibility of ruinously large medical bills. Now we are all up to our elbows in an enormous and seemingly uncontrollable medical care cost inflation, to which Medicare and Medicaid have greatly contributed. Similarly disquieting examples

I am grateful for comments on earlier drafts from my colleagues Emery Castle, A. M. Freeman III, Charles Hitch, Robert Mitchell, Henry Peskin, Kerry Smith, Walter Spofford, William Vaughn, and William Watson. Nina Cornell, Terry Davies, Ernst Habicht, David Kinnersley, and Allen Kneese also saw and were kind enough to react to an early version. An anonymous reviewer for this journal also provided useful suggestions. None, of course, bear any responsibility for my use (or misuse) of their suggestions or for the resulting product.