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This chapter examines the wider public health debates that are gathering pace in many countries that have concluded that merely funding health systems as presently configured is unsustainable. It explains that that most of the gains in population health have less to do with health care services and more to do with factors and policies outside health care. It suggests that health services alone are insufficient on their own and in the absence of an ecological approach to health that recognises the importance of structural determinants on health.

This chapter provides an assessment of the current state of the health debate in Great Britain. It discusses some of the key elements of the policy cleavages considered in the preceding chapters and highlights the relevance and importance of Robert Alford's framework and his political analysis perspective as an aid to understanding health systems. It also offers an alternative approach to the pervasive influence of markets and competition in health system reform to illustrate the essentially political nature of health system reform and one that is far from being evidence based.

This chapter examines rationing and priority setting in the health care sector. It investigates why rationing is no longer much discussed in contemporary health policy debates, while it was on every policy maker's lips just a decade ago. It explores how the issues of rationing and priority setting are being addressed in health systems that continue to have to manage growing demand with limited resources.

This chapter examines Hillary Clinton's leadership during the congressional health care debate and the investigations surrounding Whitewater—an era of her news biography marked with subterfuge and deceit. The overarching message communicated by the press was that during the health care debate, she once again talked too much and exerted too much control over her husband and his administration. Contrastingly, Clinton's unwillingness to talk enough served as evidence of her illegal wrongdoing during the Whitewater investigations. During both controversies, Clinton was pictured as smiling through the tumult, promulgating a sense of discordance between the seriousness of the allegations and her public comportment. She would consequently be disciplined through a rhetoric of violence for her outspokenness and her spatial violations as she was punished for such political and legal impropriety, corroding, once again, idyllic notions of authentic womanhood.

Most Americans see the need for a national health policy that guarantees reasonable access to health insurance for all citizens, but some worry that a universal health insurance system would be inefficient, create excessive fiscal risk, or demand too much of them, either by increasing their taxes or by rendering their own health insurance unaffordable. After describing these three objections and the role they play in health care debates, the introduction outlines the contents of each chapter. It concludes with some remarks about how data will be handled in the book’s later chapters.

The principle of “accountability for reasonableness” seems both wise and full of common sense, but several doubts and questions remain. In a political system such as that in the U.S., where the highly polarized and contentious debate on health care reform is which is ongoing, decision-makers would likely be unable to carry out these principles even if they were committed to them. Moreover, for a “fair deliberative process” to occur, a range of stakeholders in this process must exist, but the discussion content is unclear. To add to the murkiness, the definition of “more deliberative”, how to find “fair-minded people” to carry out “fair process”, and the best pedagogical method for educating all stakeholders in this principle are all currently ambiguous. While raising these questions, the author does not mean to deny that accountability for reasonableness is a reasonable idea.

This book will ask whether universal health insurance systems are objectionable on the ground that they are inefficacious, fiscally risky, or require that individuals bear excessive personal costs. These issues are of serious philosophical interest, but there is also substantial evidence that opinions about fiscal risk, efficacy, and personal cost drive many Americans’ actual views on health care. This chapter surveys the polling data about these issues. The end of the chapter discusses the limitations of this evidence as well as alternative hypotheses about the drivers of the health care debate.