ABSTRACT
Issues of access to health care, general concerns regarding allocation of health care resources, and more recently, specific arguments about the legitimacy and efficacy of health care rationing have been items central to policy debates during the last fifteen years. Yet, for nearly three decades, in discussions among health care theorists and policy analysts, the basic terms of the debate have remained subject to controversy (Fried, 1975, 1976; Lewis, Fein, & Mechanic, 1976; Outka, 1974). To speak of allocating health care resources, for example, assumes that we can establish priorities among various levels of health care needs; yet, such priorities themselves require and incorporate assumptions about the meaning of health as a general concept. According to the World Health Organization, health should be understood as “a state of complete physical, mental, and social well-being” (Callahan, 1973). If we are inclined to be generous in our judgment, we will interpret that definition as idealistic rather than realistic. That is to say, it expresses our aspirations and may, though only if refined and operationalized, illuminate our policy choices in some general way. But the WHO definition does not apply to the current reality of health care delivery in the United States, or in any other nation for that matter. Moreover, such breadth of definition may well “over-medicalize” some needs which are better addressed, as objects of policy choice, in other than “medical” terms. Obviously, adequate housing and proper nutrition are basic needs, and providing them to all citizens would dramatically influence health outcomes for the better. But for reasons of conceptual clarity and of effective legislative division of labor, we quite properly view housing and nutrition as spheres which are linked with, though separate from, the sphere of “health care” needs, as usually understood.
