This archive report was first published on 15 August 2019.
On August 15, 2019, the US health care system was criticized for its lack of basic justice and economic efficiency. The system often creates perverse incentives favoring the overtreatment of diseases, which can be avoided by treating sick people fairly.
One possible solution is to revise and reinforce the Affordable Care Act (ACA) rather than repealing and replacing it. The ACA was successful in expanding coverage for effective treatments and reining in some spending, with about 90 percent of Americans now covered by health insurance.
However, the law can be improved by reducing the high costs of drugs, co-pays, and deductibles. Instead of calling for improvements, Republicans and many Democrats are threatening to dismantle the law, which would be a tragic mistake given the lack of consensus on how to replace it.
Reinforcing the ACA should include a voluntary public option, or 'Medicare for more,' that would coexist with common-sense improvements to private employer-based coverage. Employers can also use their leverage with private insurers to insist on health plan performance metrics and innovations like digitally based care systems that track medical problems before they become dangerous.
By revising and reinforcing the ACA, the US can benefit all Americans without threatening anyone with the loss of hard-fought, lifesaving health coverage. This approach is not only economically sound but also ethically imperative, as it prioritizes the well-being of all citizens, including those with life-threatening diseases.
Amy Gutmann, the president of the University of Pennsylvania, and Jonathan D. Moreno, a professor of bioethics, are authors of the forthcoming book 'Everybody Wants to Go to Heaven but Nobody Wants to Die: Bioethics and the Transformation of Health Care in America.'
