ISSUE ADVISORY (2019) - Health Care

How Can We Bring Costs Down While Getting the Care We Need?


This advisory is part of our Hidden Common Ground with USA Today and Public Agenda. It will be used in deliberative NIF forums conducted between February 10 and March 13, 2020.


Scroll down for the Health Care issue advisory and other related materials.

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Americans, individually and as a nation, are worried about high health-care costs. Many of us fear that skyrocketing drug prices and surprise medical bills could keep us from getting the care we need or ruin us financially whether we have insurance or not. Businesses and governments also face increasing costs.

  • The United States spent $3.5 trillion overall on health care in 2017, which averaged out to about $10,739 per person. That included what individuals paid, what businesses paid, and what the government paid.
  • Other wealthy countries spend about half as much as the US does—on average, $5,280 per person. Yet people in France, Canada, Australia, and other countries with similar economies are healthier and live longer than Americans.
  • The way we pay for health care is complicated. Some 67 percent of Americans have private insurance, mostly job based. Others are covered by government programs for seniors (Medicare), people with very low income (Medicaid), or the military. About 9 percent—28 million people—had no insurance at all in 2017.
  • Prices are unpredictable and confusing. Rates are negotiated between insurers and providers and vary widely across states as well as within metropolitan areas. A common blood test in Beaumont, TX, costs $443, nearly 25 times more than the same test in Toledo, OH, where it costs $18.

Our system developed bit by bit over decades. Our largely job-based way of paying for health care began during a World War II wage freeze, when businesses began offering insurance to compete for scarce workers. In 1965, Congress enacted Medicare and Medicaid. The 2010 Affordable Care Act expanded Medicaid, created “marketplaces” for buying private insurance, required insurance companies to accept people with preexisting conditions, and made other reforms.

Health-care costs continue to grow faster than inflation. No wonder a recent Gallup poll found that health care availability and affordability still top the list of Americans’ worries. One in four said they have skipped treatment because of the costs, and 77 percent said that rising costs will damage the US economy.

How can we bring costs down while getting the care we need? This issue advisory looks at three ways of making our health-care system sustainable and fair. Each option offers advantages as well as downsides.

  • If we create a single public program to pay for everyone’s health care, would we gain universal coverage but lose individual choice?
  • Can more incremental reforms bring costs down and still get everybody covered?
  • Should we take responsibility for our own choices in a more transparent and competitive marketplace even if that means leaving those who make poor decisions to suffer the consequences?