Dr. McCullough has peeked out from his bunker near the Alamo long enough to espy cultural homogenization creeping toward him under the cover of my editorial on rationing [1]. However, I fear that his paranoia at the suggestions that 1) any other nation might have something to teach us about health reform or 2) that talk of solidarity will grind out the cultural, religious, and ethnic differences that make the United States a great nation may have distorted his perception of my views.

I could not agree more with Dr. McCullough that the United States does not have a health care system to reform. One of the few things that the Clinton administration did understand in its bungled effort at reform was this fact. I do not believe, as Dr. McCullough suggests, that if Americans could simply import the loving, neighborly value of solidarity from the Swedes into our collective moral psyches, our health care costs would dip and the quantity and quality of services available here would improve. Health care in Sweden costs a lot, and despite the country's relative cultural homogeneity, those who dwell there spend endless hours contentiously arguing about what to do about this expense.

My point in citing the Swedish approach to setting priorities was that in trying to Figure out what is good to pursue in health care, debates about rationing in the United States bog down. They probably do so for some of the reasons Dr. McCullough cites. However, if we could follow the Swedes, not so much in importing the content of their values but in their moral focus, by starting our debates about rationing and setting priorities over what is not allowed and what is morally off the table, we will get a lot further in reforming our mishmash of a health care system than we have to date.