ABSTRACT
American health care is so conspicuously unjust that the need for reform is now policitically as well as philosophically inescapable. The numbers that testify to this need are becoming grimly familiar but are still worth rehearsing. In 1991 the United States spent 13.2 percent of its gross domestic product (GDP) on health care-$751.8 billion-more than was devoted to education and defense combined. The expenditure curve is rising steeply. If its slope is unchanged, by the century's end 18 percent of our substance will be devoted to health care, while education, housing, the arts, and other social goods will have to go underfunded.1 Despite the glut of spending, over 14 percent of those living in the United States have no health insurance, and an even greater percentage-amounting to perhaps 60 million Americans-are significantly underinsured.2
