It's not easy reviewing your own book. Should it get three stars or four? Two thumbs up? Or should that be three? These decisions are so wrenching I'm going to put them aside and talk about something completely different.

The biggest problem with health policy folks (other than lacking a sense of humor) is that they almost never tell us about their vision for health care. They can chatter endlessly about minor policy matters, but fall completely silent when it comes to the big picture.

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Michael Moore thinks the profit motive should be removed from health care. Many others agree. They are not talking about profit in the narrow sense. What they really want is to remove self-interest from health care. But if people do not act on the basis of self-interest, what else is there? Altruism.

If it is good to deliver health care altruistically, doesn't the same argument apply to food, clothing, and shelter? What if the whole economy were structured so that all our needs were met by altruists rather than egoists? What would such a world look like? I'll start there and then wend back to health care at the denouement.

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