Foreword: Health Policy's Fourth Dimension

Document Type



The most up-to-date version of this piece can be found in the Duke Law Scholarship


While American policymakers and commentators have traditionally focused on three aspects of the health care system -- access, cost, and quality -- they have neglected an arguably coequal fourth issue: equity in the distribution of health care costs and benefits. This brief introduction to a symposium volume entitled Who Pays? Who Benefits? Distributional Issues in Health Care suggests that the American health system takes excessive resources from working-class payers of health insurance premiums to finance an industry that serves the interests of others far better than their own. In addition to summarizing several aspects of the unfairness problem, the Foreword urges policymakers and the academic community to pay greater attention to issues of distributive justice in health care, lays out a research agenda for extending the work begun by the symposium's contributors, and expresses the hope that deeper understanding will add to the urgency of reforming American health care.

Date of Authorship for this Version

January 2007