Proper health care for all the citizenry has increasingly become a concern for all national governments in recent decades. Ihe ongoing process of health care reforms in the United Sates has reached an intensive phase with the first years of a new administration pledged to make health security a centerpiece of domestic policy.

Part I of this two-part article described a missing critical component of the voluminous demographic and cost data, which are presently available to decision-makers and the public. Without this humane component of health care's objectives and limits, a clear-headed formulation of health plans and a prudent and humane selection of the optimum for the country as a whole and for individuals in special circumstances is severely handicapped.

Because the health care system is a very complex and specialized entity, one component that can be measured by a universally comprehensible metric is cost -and that has been the primary focus of most analyses of health care options. We have chosen to begin with a more fundamental measure of health care's humane effectiveness, and have offered for initial consideration a measure of human suffering and its relief.

As explained in Part I, the dukkha is a direct quantitative unit of suffering, applicable to the determination of the amount of suffering of all kinds across the board, as experienced and quantified by the sufferer. The number of dukkhas endured by a group of individuals is the product of (number of persons) x (average intensity of suffering on a scale of nine) x (duration in days).

Previously, not a single figure for any illness has been published; nor has there been an attempt to rigorously measure and sum suffering for patients and populations. By way of illustration, a set of suffering values for ten illnesses was presented in Part I. An abbreviated extension for six illnesses and eight medical treatments is given in Table 1 below.

These dukkha data can then be coupled with illness incidence, cost, medical, and social information to provide sideby-side comparisons of the emerging alternative health care proposals.

This Part II exemplifies the use of this dukkha information with the associated incidence and cost. Ihe resulting econo-panetic implications are consolidated in Table 2.

We believe that attempts at this knowledge of health "numerator" data would be of considerable value in the understanding of, and decision-making for key public health issues. In addition to the discussion in Part I, the following are several more topics that can be extrapolated from having both humane numerator and cost denominator quantifications before policy decisions.

• Total amount of medical suffering potentially prevented and/or relieved in the national population by each of the proposed health care plans per million dollars appropriated;

- • Total amount of medical suffering rernaining unrelieved by each of the proposed health care plans at various levels of overall appropriation;

• Amounts of medical suffering potentially relieved and unrelieved within

•~arious subclassifications of people by each of the proposed health care plans at various le~els of overall appropriation.

A reasonably reliable comparative analysis of this sort will facilitate the process of arriving at a prudent formulation, selection, and progressisre improvement of national health care plans and humanely cost-effec¹ive programs.

Discussion

Ihe common availability of data of the type illustrated in the tables in this article and in preceding Part I would be most helpful in addressing the inescapable questions perennially confronting government officials, community leaders, and others concerned with public health. Typical of the critical issues are the following:

• What fraction of the outerall budget should be allocated to health care?

One of the significant criteria has to be the comparative amounts of net suffering among the respective budgetary components thereby burdened on the citizenry.

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• Given a limit for total health care expenditures, how should the resources be

distributed among the various illnesses, regions of the country, and categories of people?

• How should the funds available for medical research be divided among the various illnesses without effec¹ive palliation and remedy?

A comprehensive, standardized, and internationally accepted set of continually updated medical dukkha and econo-panetic tables would also contribute to decisionmaking in areas far beyond the immediate setting of individual illness. Several examples are sufficient to make the point.

• In jurisprudence: increased uniformity and "fairness" in the award of damages for suffering in legal suits.

• In insurance: higher predictability and confidence in the setting of related premiums.

• In the transition zone of public health and communal well-being: extension of the medical dukkha table can aid health policy decisions that include higher order panetic ramifications. What would be the amount of suffering generated in others by a given illness? For acample, the dukkhas flowing from the worries of the family members, the finanaal burdens and associated sacrifices on the part of those who have to pay the bills, and the sadness and hardships of bereaved dependents?

How far should the concerns of physicians and other public health professionals be stretched into the domain of societal wellbeing from the narrow confines of medical suffering of the patient alone to the associated distresses of related others? In particular, how do the econo-panetic efficiencies of the various mixes of preventive and remedial measures compare? How should public policy go about taking this factor into explicit account?

• In the implications of panetic responsibility in personal and social ethics: the enormity of breaches in ethics takes on a new dimension of astareness when the amount of suflfering engendered by the causing or passing on of various illnesses is dearly laid out and appreciated.

Condusion

Sound medical dukkha tables and econo-panetic analyses can play critical roles in the prudent formulation, selection, and continuing impro~ement of national health care plans and medical treatment options.

Their usefillness can also be extended far into the realms of other human concerns, such as business, law, ethics, and panetitude.

The institution in the best position to compile authoritative arrays of these kinds appears to be the national govemment. A comprehensive and provisionally usable set can be devdoped by Anerican public health agencies within a relatively short time.

We urge that serious consideration of their development be given by the responsible public health leaders.

This will refocus the crux of the debate on suffering and its reduction instead of dollars, sources of revenues, and managerial procedures and prerogatives.

What is essential at this point in time is not wishful debates over the speed of progress in the research on and oompilation of the pertinent figures. What really matters is that the arduous task be begun at the earliest date by sufficient numbers of talented persons in or out of gourernment. The present and continuing requirement for the enhancement of basic human well-being everywhere is obvious.