Imagine a nation of 307 million people representing 5 percent of the world’s population who are privileged to be using 50 percent of annual global health expenditure (more than $6,000 per person per year) for their own health care. Imagine that they recognize how privileged they are in comparison to over 60 percent of the world’s population (on whom annual expenditure on health is less than $ 40 per person).’

Imagine that they acknowledge the magnitude of their privilege by ensuring that all their citizens will have access to the best of medical care throughout their lives: all pregnant mothers will be well cared for; all children will receive all the vaccines and other preventive medicines available to ensure that they have an equal opportunity to reach their full human potential and an average life expectancy of more than 80 years (as compared with a life expectancy of 40 to 60 years in many countries); and all will have access to effective diagnostic, rehabilitative, and treatment modalities throughout their long lives.

Imagine that high cost is not a deterrent to provision of health care. Indeed, expensive, sophisticated, and effective medical and surgical treatments are strongly supported as they provide great benefits for many.

Similarly, there is support for researching costly new treatments that are essential for making progress. Imagine also that this society understands that inappropriate use of very high-cost investigations and treatments with minimal beneficial effects leads to denying much more effective, lower cost treatment to many other patients.

Imagine that they are a people who have religious faith, are well educated, have the capacity for rational moral reasoning, and are aware that all humans are mortal and will one day die. Imagine their wish to live long lives during which they would suffer minimally before dying without being subjected to aggressive, largely ineffective, and often dehumanizing interventions that could inflict physical and emotional suffering and crippling financial hardship on them and their families.

Imagine the serenity of these people opting to die peacefully and with equanimity when they are no longer cognate and have entered the terminal phase of long, satisfying, and productive lives.

Imagine that they would not want more than a small proportion of health care expenditure to be spent on administrative or legal fees so that these resources could be used optimally to ensure prompt access to treatment without significant waiting lists. Imagine their rejecting litigation and choosing some form of no-fault compensation to cover unforeseen medical complications that were not due to blatant negligence.

Imagine that while they would be in favor of research to advance the practice of medicine they would also realize the limits of life and of what medicine can achieve.

This is what could be achieved by the United States with the human and material resources this country enjoys. Such an exemplary society would achieve high standards of health and be admired globally.

Instead, of taking a hard look at an unsustainable health care ”system” and responding to the sanguine appeal for a revolution in spirit, as an article in The Nation last winter suggested, there is unseemly squabbling over sensible reform measures with little awareness of the much better health care and health that could be enjoy at significantly lower cost. There also seems to be failure to appreciate the extent of the privileged access to almost all that modern medical care offers — in contrast to the extremely limited health care to which most people globally have access.

While this society is tragically squandering the potential to achieve high quality lives and health-care for its citizens it is gradually, but progressively, losing well deserved and widely shared admiration for its many wonderful achievements. It is also losing the opportunity to lead the world into a perilous but highly challenging era in human history and global health.

Solomon R Benatar, MBChB, DSc (Med)., is an emeritus professor of medicine at the University of Cape Town, South Africa; founding director of the Cape Town Bioethics Centre; and a professor in the Dalla Lana School of Public Health at the University of Toronto. solomon.​benatar@​uct.​ac.​za