Most people would be impressed by the high quality of medicine available to most Americans. There is a lot of specialization, a great deal of attention to the individual, a vast amount of advanced technical equipment, and intense effort not to make mistakes because of the financial risk which doctors and hospitals must face in the courts if they handle things badly. But the Americans are in a mess. The problem is the way in which health care is organized and financed. Contrary to public belief, it is not just a free competition system. To the private system has been joined a large public system, because private care was simply not looking after the less fortunate and the elderly. But even with this huge public part of the system, which this year will eat up 84.5 billion dollars—more than 10 percent of the U.S. budget—large numbers of Americans are left out. These include about half the 11 million unemployed and those who fail to meet the strict limits on income fixed by a government trying to make savings where it can. The basic problem, however, is that there is no central control over the health system. There is no limit to what doctors and hospitals charge for their services, other than what the public is able to pay. The number of doctors has shot up and prices have climbed. When faced with toothache, a sick child, or a heart attack, all the unfortunate person concerned can do is pay up. Two-thirds of the population are covered by medical insurance. Doctors charge as much as they want knowing that the insurance company will pay the bill. The medical profession has as a result become America’s new big businessmen. The average income of doctors has now reached $100,000 a year. With such vast incomes the talk in the doctor’s surgery is as likely to be about the doctor’s latest financial deal, as about whether the minor operation he is recommending at several thousand dollars is entirely necessary. The rising cost of medicine in the U.S.A. is among the most worrying problem facing the country. In 1981 the country’s health cost climbed 15.9 percent—about twice as fast as prices in general. Doctors and hospitals try hard to avoid making mistakes because______.

A. they fear to be sued by the patients
B. they care much about their reputation
C. they compete for getting more patients
D. they wish to join the private medical system