We wrote this book for two reasons. The first is that well-meaning but uninformed proposals to reform the health care system can harm people – really hurt those who trust the government experts and politicians to do their public job of selecting health care policy that prevents predictably harmful consequences as conscientiously and as well as they, not in government, do their private ones. People have died because their diseases became untreatable while they waited to be seen by their government health care plan. Others face financial ruin because they encountered medical catastrophes without adequate insurance. People deserve better. Openness, respect, and deference to the individual and the household must be evident in the social institutions and structures involving health care. Professed good intentions are not enough: health care arrangements must be uniformly compassionate, consistently effective, persistently efficient, and financially sound. Creating a system that tends naturally and organically in that direction does not happen by accident. It must be inculcated with sound principles and nurtured by their thoughtful application, coupled with the avoidance of bad principles, before so large and vital a sector as health care can be further affected by political action.

The second reason is that – contrary to widespread belief – it is eminently possible to implement a health care framework for the United States that meets the fivefold requirements of universal access, patient-centered personally responsive portable coverage, respect for incentives for high-quality care, fail-safe cost containment by government of its injections into the health care sector, and sustainability – and to do so efficiently. For the most part, the answers to Americans' health care concerns have been available for a long time.