These are complex times in health care. We’ve seen historic
advances in technology, but we’re also facing unsustainable
costs.

It is that complexity I wish to address. It is the subject of debate
in the United States as we approach our presidential election.
It is certain to be a part of the congressional agenda during
the next year. It is reflected in similar debates in presidential
cabinets across the world.

The health care debate worldwide is framed by two competing
but rather divergent philosophies about the role of government.
One philosophy holds that governments should own the health
care system. This philosophy proffers that government should
decide who gets care, how much care is given, and the price of
care.
A competing philosophy is that government should organize the
health care system. This philosophy holds that governments
should set rules under which the market will operate, resolve
inequities and subsidize those who are in hardship.

My own view is that governments should assume responsibility
to assure that citizens have access to an affordable insurance
policy. Governments should organize markets to produce that
result; and if a person is in hardship, governments should help
them pay for it.

The reality is that both of these philosophies are currently
present within the health care system of the United States. Sixty
percent of our insurance market is a private market and some 40
percent is currently a government system.

Neither of these works to perfection, and that is at the heart of
our dilemma. Our government system lacks consumer sensitivity.
Our private market has gaps in availability. Both are flawed in
their current form.