Health care has become an enormously contentious political and intellectual issue over recent years, both in the United States and else-where in the world. Previously the debate had taken place mainly among technical people - academics and health specialists. Now everyone is discussing health care. Indeed, it has moved so far up the political agenda that a dispute over the size of the Medicare premium recently shut down the United States government. I cannot do justice to all of this debate in a short address. I will give a brief overview of the big picture as I see it, and then focus on one part of that picture in greater detail.