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Dr. Kissick was an active participant in the drafting of Medicare legislation in the 1960s and for the past twenty-five years has held joint positions in a medical school and a business school where he has specialized in healthcare management. Drawing on his long experience in the field, he discusses the dimensions of the current crisis, the financial and medical implications of alternative proposals-- including the program put forth by the Clinton administration--and the requirements for long-term strategies.

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In chapter 10 of Medicine's Dilemmas we are asked if there are "unalienable rights to health or health care?" The answer to this question suggests the direction in which health care should be organized. Kissick states that "everyone deserves the finest health care attainable, provided someone else pays." As he indicates, society has infinite needs, but finite resources. Kissick presents a model, the "Iron Triangle of Health Care," in which the equal angles consist of access, cost containment, and quality; a change in any angle compromises the others. Since 1971, health care professionals have reached a consensus concerning the requirements of a model health care system; these components are universal access, comprehensiveness, containment of costs, quality, self-regulation, accountability, and responsible use of services. Three methods of payment are proposed to provide health care: single payer, play or pay (employer mandates and public taxation), and market reform (tax credits to purchase health insurance). All three methods do not, however, meet all of the requirements of a model health care system. The author aptly describes some of the cultural, historical, and governmental issues that influence our health care system and, ultimately, argues that a federal health care policy with individualized state interpretation and implementation is probably the best. Upper-division undergraduate through professional. C. J. Wintz; University of Texas Health Science Center at Houston