But the problem is that since 1960 health-care spending has grown significantly faster than the economy, meaning that we're spending an ever larger portion of our incomes on medical core. In 1960 health care constituted 5.1 percent of the U.S. economy; in 1980 it constituted 8.8 percent; today it constitutes 13.3 percent. Meanwhile, private health-insurance premiums which rose by 14 percent last year alone are becoming unaffordable for ever Americans. The number of things we can do to pay for them. 41 millions of our citizens are now uninsured. So the key question is not whether health care should be rationed in the United States ; it already is. Rather the question is how health care should be rationed. How should the potential benefits of reduced pain, improved quality of life, or extended life be weighted against the high costs of the medications or procedures involved? And who should weigh them? These are hard questions with high moral stakes. But we do hope that the health-care system will cover more people.

　　Translate Reference：

　　 因为存在缺陷，所以美国的医疗保健在过去几十年里进行了重大改革。心脏疾病导致的死亡自 1970 年以来下降了 40% 。由于较先进的监测和治疗，癌症死亡率自 1990 年以来一直处于下降趋势。总的来看，医疗进步使美国人均寿命从 1950 的 68 岁提高到现在的 77 岁。

　　美国人不仅提高了寿命，而且还提高了生活质量。 65 岁以上患有至少一种长期残疾如在无人帮助下不能独立行走，或不能自己穿衣的比例从 1982 年的 20% 以上下降到 1990 年的 20% 以下。视力矫正手术的发展，以及其他药品和治疗程序的发展，使得许多美国人历史性地延长了与年轻有关的生活乐趣。

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