It is difficult to disagree with Dr. Glusker's contention that health education is worthwhile. However, the United States probably devotes more energy to media coverage of health-related issues than does any other country. Despite some impressive recent declines in smoking prevalence and deaths from drunken driving, our national health indices still trail those of other developed countries. Whether health education could reduce expenditures is debatable. To the extent that education encourages healthier habits, it could at least postpone illness and disability and could perhaps even reduce medical care. To the extent that it stimulates diagnostic tests such as cholesterol and prostate-specific antigen screening, routine sigmoidoscopy, and mammography, with their resultant follow-up procedures, health education could actually increase costs.

Dr. Sugar is concerned that health care reform might lead to rationing for the 80% of Americans who are currently satisfied with their medical care. Whether the public will support basic health care for everyone is, of course, a political question. We should not forget, however, that millions of Americans, including those who are uninsured or underinsured, currently experience rationing. Medical insurance reform, as advocated by Dr. Sugar, is certainly a laudable goal, but it will not, by itself, guarantee universal coverage. If by rationing Dr. Sugar means that not everyone will be able to get every form of health care they desire, then that has already happened and will accelerate, whether or not Clinton's health plan is passed.