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To the Editor: In asking whether US health care is the best in the world, Dr Starfield¹ overlooks a much more fundamental issue: the absence of nationally agreed-on goals and directions for promoting the good health of our citizens and the absence of a nationwide system for implementing health goals.

Without clear health policy goals and clearly developed ways of directing the health care effort in a goal-directed manner, US health care will be determined by "the invisible hand" of a relatively unregulated health care market that values efficiency, economy, cost-saving, and the most diluted, adulterated product that the public will tolerate. These de facto health care goals tend to promote the financial interests of an industry (health care financing) in preference to the public's health interest. The false assumption behind the current adulation of market forces is that an informed "consumer" will make "rational" decisions and choices about health . . . [Full Text of this Article]