Mr. Gordon’s review of how the United States fell into a health system with intractable cost problems was masterly. It takes a historical viewpoint to understand the situation, which many economists persist in treating as a problem in tax theory or regulation.

Two aspects of health care have to change, not one. If payment reform is to succeed, then delivery reform should precede or parallel it, or people could find themselves covered, but with no services available. Or, we could pass insurance-access bills, and simply inflate the health system further, if there were no checks and balances on hospital and physician resource decisions.

Planning public-policy interventions in health care has logic on one side w and the weight of history on the othj? er. What we still do not understand how to do is gain support for an improved system from those who would inevitably have to change—and that includes most of us.

Thank you for a very well-crafted overview of health care’s evolutionary life cycle to this point.