Abstract

It is not too early to suggest that the attempts to place medical care in private hands (through group insurance arrangements) has not fulfilled its promise—or better, the promises that were made for it. Yet history has not been kind to plans to make government the single payer, and the laudable progress in medical technology has placed high-technology medical care beyond the reach of most privatebudgets. In this paper I suggest that the major problem of the U.S. health care system as presently conceived is a failure of legitimacy,and I put forward a proposal that purports to solve that problem. The proposal is to localize health care, on the model of a public school system, on the argument that such localization will answer most of the questions of legitimacy at the core of the private insurance imbroglio, provide a brake for medical costs, while preserving our ability to take advantage of the most advanced medical interventions. I present some initial arguments for the proposal, but await its proof in the dialogue emerging as the present insurance system collapses.