The Health Care Debate

Whether individually or collectively, people want health care that maximizes their health potential and meets their health goals. They also want to ensure equitable access to essential health services. Providing these wants is challenging when health care costs rapidly rise, the effectiveness of component health services in preserving or improving life and well-being remains uncertain, and unexplained variations occur in the utilization of services by different providers for seemingly similar patients.

The health care debate is framed by diverse views of the best way to deliver health care, including:

One view is that individuals should be free to choose their own healthcare and that private market forces and competition can most fully serve consumers’ interests in the delivery of health care. In this context, information that is publicly available, such as hospital-specific mortality rates, is perceived to help improve quality by eliminating poor performers and rewarding superior ones.

Another view is that healthcare is a public good, like highways and education, that the government should provide on a universal basis to all people. This viewpoint is consistent with a utilitarian ethical framework that defines the right action as the one that provides the greatest happiness to the greatest number of people. It also suggests that allocations should be based on cost-benefit analysis, in which alternative healthcare systems are evaluated on the basis of their ability to deliver the highest net benefit to patients (i.e., do more good than harm).

Still others believe that allocations of healthcare resources should consider not only the current needs of those who exist today, but should include an obligation to future generations. This is consistent with the ethical philosophy of stewardship, which defines an individual’s moral obligations to society and their descendants.

There are those who feel that the role of government in delivering healthcare should be limited to such functions as maintaining order. This viewpoint is consistent with a libertarian ethic that supports private ownership of healthcare services and insurance.

A major concern for many is the possibility of fragmentation and incoordination of health care. This issue is exacerbated by the expansion of care in nontraditional settings and the use of a variety of methods for managing health care costs. In addition, it is important to keep in mind that the delivery of healthcare involves a highly technical and complex set of interactions between doctors and their patients.

While the rapid growth of healthcare prices has outpaced that of other consumer goods, it is unlikely that rising wages and inflation in the rest of the economy will have a large impact on health care costs in the near future. It is more likely that costs will continue to increase rapidly as the delivery of healthcare continues to expand and become increasingly specialized and technologically sophisticated. It is important for policy makers to develop and implement policies that will help to control this increase in healthcare costs. This will require a combination of cost containment and performance improvement efforts that involve all components of the health care system.

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