What health insurance should cover and pay for represents one of the most complex questions in national health policy. Israel shares with the US reliance on a regulated insurance market and we compare the approaches of the two countries regarding determining health benefits. Based on review and analysis of literature, laws and policy in the United States and Israel. The Israeli experience consists of selection of a starting point for defining coverage; calculating the expected cost of covered benefits; and creating a mechanism for updating covered benefits within a defined budget. In implementing the Affordable Care Act, the US rejected a comprehensive and detailed approach to essential health benefits. Instead, federal regulators established broadly worded minimum standards that can be supplemented through more stringent state laws and insurer discretion. Notwithstanding differences between the two systems, the elements of the Israeli approach to coverage, which has stood the test of time, may provide a basis for the United States as it renews its health reform debate and considers delegating decisions about coverage to the states. Israel can learn to emulate the more forceful regulation of supplemental and private insurance that characterizes health policy in the United States.

The world is a dangerous place, and so is the health system; hospitals in particular.

This was not self evident to this author before observing 20 years of health policy evolution in Western countries, together with some personal experience. This perspective is furthered by the two volumes reviewed here. In the view of this author, health policy is moving beyond, or at least supplementing, the structure and process emphasis, provided mainly by economists, but with under-girding from other disciplines, that has dominated during the last two decades. The new focus in health policy is not only on quality, but on what to do when quality breaks down and we cannot rely, however much we desire, on a clear systematic framework of standards, incentives, regulations, and controls (Chinitz, 2002). How do we go forward in a realm where the stakes are so high? While not providing all the answers, the two volumes examined by this essay certainly lay out the dilemmas and provide some realistic propositions, for moving forward in health policy and management. And, not surprisingly, economics loses its pre-eminence to other disciplines, especially law, organizational theory, and management.

The words of Paul Simon capture the essence of what the courts are called upon to deal with when adjudicating matters of health. Wealthier and healthier neighbors living in the upstairs apartment are, all things being equal, not overly interested in raising the floor of their apartment in order to create more space for those in the apartment below. The floor is tangible, measurable and movable, and thus a subject where science can contribute much. However, where to locate the floor is a matter of values and thus largely in the realm of politics.

Resorting to the courts in matters of public policy can be seen as the residual of the inability of the remaining two branches of government, the legislature and the executive, to succeed in allocating resources and regulating the system. When the combination of science (bureaucracy) and politics (legislation) falters, enter the judiciary.

Four studies, each on health technology assessment (HTA) in a different country, are presented in this volume. Conveying differing levels of sensitivity to political aspects of HTA, their storylines are similar in terms of the importance of the institutional structures that produce HTA and mediate its influence on health policy decision making. Regarding the internal politics of HTA, the latter appears to have developed in a relatively depoliticized environment, supported by a dense and varied web of institutional sites for funding, production, and consumption of HTA, buffered from the capricious impacts of electoral politics. Regarding external politics, HTA in all the countries began with relatively politically innocuous studies of technologies recognized to be of major import to national health systems or researcher-initiated studies. However, with increased focus in health systems on explicit determination of health benefits baskets, the role of HTA has become more high profile. This means that political accountability for the entire HTA process will increase. The implication is that future management of HTA programs will require self-conscious attention to the building of institutions capable of handling the delicate process of integrating science and politics in health policy.

T. S. Eliot is remembered as a champion of elite tradition who struggled to rescue an autonomous and uncompromised high art from the encroaching tide of mass culture. However, the essays, poems, and plays of his early career reveal an Eliot who believed that the ever-deepening division between the “high” and the “low” in culture represented a form of social disintegration that threatened to make art irrelevant. Rejecting the sacralization of high art as a stultifying bourgeois misappropriation, Eliot allied himself with the lower class and its participatory engagement with popular culture—an engagement that Eliot himself shared. Despite a complex personal ambivalence manifested in his poetry, Eliot sought to reconcile the dissociated levels of culture by theorizing and attempting to create a new public art form: a poetic drama based on such popular forms as music-hall comedy and jazz.