RÉSUMÉ

Our health care system is a natural social artifact, something we have created because of natural features making us subject to illness and bodily faults. It is like language in that its current structure is the result of many different decisions by many different individuals. Like language, it is not fixed but evolves because many different individuals with differing interests and different ends make different decisions that affect our health. Our health care system is thus a hodgepodge, with inefficiencies and significant failures to provide even the basic minimal health care goods to so many. It is a tragedy that preventable medical mistakes are the third leading cause of death, after cancer and heart disease, with over 400,000 deaths a year, but it is also a telling mark of a system that fails in achieving its basic goals. Our health care system ought to be organized to achieve a set of basic goods−that birth and infancy occur so we have the highest chance of continuing to live without harm, that those of us who live have the best preventive care so that we will be least prone to disease and bodily faults, that those of us subject to disease and bodily faults are well taken care of, that when we are elderly, we receive adequate care, that we have each and all of these without significantly harming such other interests as our financial well-being, and that every one of us has reasonable and assured access to these minimally adequate basic goods. Every complex human enterprise has effects, some a result of its design and some of its incoherence. The 400,000 deaths a year from preventable medical mistakes are unintended, unwanted and unwarranted in a system that ought to be designed to achieve the basic goods of any health care system.