The debate on the future structure of the U.S. health care system has centered on the Affordable Care Act and legislation which would repeal and/or significantly alter ACA provisions.

However, given its complexity and the differences of opinion, the basic discussion as to how the U.S. health care system should be structured has been going on for the past half-century or more.

Many of the core issues that have applied to these past discussions still remain relevant today:

Access versus affordability

Some of the recently proposed health care legislation claims to offer access to health care for everybody. This access may include high deductible insurance policies, tax credits and competing insurance markets. There have also been efforts to incentivize doctors and other health care providers to provide access for persons in rural and poor regions.

However, access does not equal affordability. Advocates of expanding Medicaid believe social programs help make health care affordable for certain groups such as those living below the poverty line and the elderly, irrespective of whether insurance is potentially accessible.

Many of those opposing Medicaid expansion believe greater access and market competition will eventually lead to lower overall health care costs.

However, the Congressional Budget Office (CBO) estimates that Medicaid rollback could lead to an increase in the number of uninsured by over $20 million by 2026 and also increase premiums over the next several years.

It’s personal

While cost and access are the key issues debated by policy makers, decisions on one’s health care are highly personal. These decisions, in many cases, involve life and death and transcend pure monetary considerations.

Health is not a commodity like a hamburger; society as a whole has to pay a higher price for each individual to receive the high quality care they expect.

Social costs and benefits

The cost of health care differs for the country as a whole as opposed to any one individual.

The cost of an infrastructure (hospitals, doctors, nurses, etc.) which provides care for all, including those who are unable to pay, must be weighed against the social benefits of a healthier population.

A key challenge for all involved is the overall cost of this care, which has been increasing at a faster rate than inflation.

The health care system accounts for one-sixth of the US economy, and is a key component of our economic growth and well-being.  

However, “it’s complicated” and requires an understanding and consensus regarding the human as well as economic trade-offs involved.

NOTE: Information presented herein is for discussion and illustrative purposes only and is not a recommendation or an offer or solicitation to buy or sell any securities. Past performance is not a guarantee of future results.