(“starting life in a test-tube”). Evidcntl, Oregonians hae beenrnlooking at opportunity costs. Medical costs vary wideK fromrnarea to area, but a fair estimate would show that successful artificialrninsemination is not cheap and that in vitro fertilizationrncost.s some ten times as much as a normal conception andrnbirth.rnIt is easy to empathize with an infertile couple who feel theyrnmust have a child at any cost, but community decisions are bestrnmade on the basis of opportunity costs to the community. Ifrnthe majority of the people believe that the birthrate needs tornbe nudged upward, a given investment can produce morernbabies if funds assigned to subsidize births among infertilerncouples are diverted to pay for births among couples of provenrnfertility.rnA new variation on the infertility theme has been recently introduced:rncreating artificial fertility among post-menopausalrnwomen. At considerable expense it is possible to implant a fertilizedrnegg (from another woman) in the uterus of a 60-vear-oldrnwoman, where it surprisingly thrives and develops normally.rnAnd one empathizes with the would-be mother. But again,rnthere is the question of community interest. VVc have good evidencernthat extra costs (of several sorts) are inrposed on therncommunity when 13-ycar-old girls become mothers. Thoughrnit may be ungracious to say so, are there not reasons for expectingrnthat 60-year-old mothers, as a class, will impose extrarncosts of a different sort on the community? Certainly their late-rnQuestionsrnupon rending another long list ofrngrunt recipientsrnhv k’ulhcriiic h IpinernWfid are ihcse uiilei– whom nobody reads?rnW ii- have 1 never heard most of theirrnnames?rnWhal”. I In-criterion goerunicnt heeds?rnI low are th(?se writer^ whom nobody reads,rngrinding oul literalure nohndv need.s,rnlinding >.iiec:ess in tiie subsidy game?rnWho circ these v riter-. »lioin nobody reads?rn In have I never licard tm kst of theirrnnames?rnborn children are more likely to become deprived of theirrnmothers before they arc old enough to vote.rnA few years ago the economist Lester Thurow estimated thatrneach new American baby requires an investment of somern5240,000 to turn it into an average citizen-worker-eonsumer.rn(Grossly abnormal babies recjuire a great deal more investment,rnand the end product is likely to be less competent to runrnlife’s race.) Considering all these facts, the mythical Manrnfrom Mars would no doubt think it odd that earthlings shouldrnview the production of children as a purely private matter, thernprerogative solely of the fertile couple. In frontier days, whenrnisolated couples took care of all the needs of their developingrnchildren, parenthood as an unqualified right made sense. Butrntoday, with every decade that passes, the larger community assumesrnmore and more of the expenses of ehildrearing. An ancientrnmaxim states that “he who pays the piper calls the tune.”rnWill public policy on parenthood and public health care eventuallyrnbe determined by this old saw?rnLast, and most difficult to deal with under a would-be universalrnhealth care system, are the middle years of life. Forrnthe wealthy few who pay their own medical bills, there wouldrnseem to be no serious problems (though medical facilities arernlimited no matter who pays the bills). No person, no committeerncan yet draw up a detailed plan for a stable system of publiclyrnfinanced health care. The final solution (if there is one)rnis unknowable.rnThe costs and benefits of publicly financed medical care duringrnthe middle years depend on many factors: the age of thernrecipient; the probable future earnings of the particular individual;rnthe probable costs of future medical treatments; and thernplausibility of further advances in medical science. Discriminationrntakes place along many logical axes, and the best weightingrnof the various factors will not be speedily agreed upon.rnControversy will continue.rnWe lid like to foresee all of the unintended bad consequencesrnof social innovations, but this is impossible almost byrndefinition: if we could accurately foresee them we would takernevasive action. After thinking long and hard, we will just havernto do the best we can with the available knowledge.rnWe mav have more success in predicting the good consecjuencesrnof a national health care system. Beyond the aggregaterngain in public health, conflict over costs should help persuadernthe general public that we live in a world of real limits. Such arnstatement would be a mere truism were it not for a stead)rneounterpressure exerted by entrepreneurs and advertisers in ourrnhighly commercial society. During the last two centuries thernreality of limits has become a radical idea. We have been urgedrnto “fly now, pay later!” Plastic money substitutes for paperrnmoney; spending is pushed harder than thrift.rnDisputes over health care may push us over the threshold intorna world in which limits become pervasive psychological realitiesrnonce more. When shortages become obvious, individual discriminationrn—electing one alternative over another—is necessaryrnif chaos is to be avoided. Discrimination by whole classesrnis both wasteful and cruel when the classes are races, as wernlearned a generation ago. But discrimination in the light ofrncommunity need and individual merit is both efficient andrnjust. Everyone likes to say “Yes!” but every explicit Yes impliesrnNo to a host of alternatives. A national health care system willrnbe well justified if it reinstates discrimination as a proper functionrnof the social order. L-rn16/CHRONICLESrnrnrn