Barney Clark expected that the operation would either kill him quickly or cure him. Unfortunately, he was wrong. He could not foresee his prolonged ordeal of dying. Nor did his doctors anticipate the incessant medical problems, tremendous cost, and troublesome ethical issues they would generate in their rush to the operating room. Moreover, most of all, the media reports did not convey to the average person how the landmark operation would change the nature of medical services for everyone.

When Dr. William DeVries exchanged Barney Clark's failing heart for a permanent artificial one, he initiated a sequence of events that will affect all patients. In time, the artificial heart program will have an indirect but certain influence on mechanisms and levels of medical insurance, the direction of medical research and the funding for it, the federal health care budget, and more. How all this works out will determine who gets what and how much medical care, how we apportion our expenditures between medical and nonmedical services, and whether individuals perceive the distribution of services as just.