Access and Ability to Pay: The Ethics of a Tiered Health Care System

The American health care system is a mess. At least 45 million Americans are uninsured. 1 The demands of Medicaid are forcing states to cut other services, especially education, and to ensure Medicare's long-term solvency would require an immediate halving of benefits or doubling of the Medicare tax. 2 Although major reforms of the American health care system are not imminent or inevitable, escalating deficiencies make an extensive overhaul more likely. 3 Indeed, leading conservatives, including former Senate majority leader Bill Frist; Bill Thomas, former chair of the House Ways and Means Committee; and Bill McGuire, former CEO of UnitedHealth Group, have publicly called for comprehensive health system reform to repair inefficiency and undercoverage in the current health care system.