The first problem to be encountered in healthcare reform is determining just what exactly healthcare is. This seems trivial until one actually undertakes to do it. Is abortion healthcare? In all circumstances? How about chiropractic care? Many people derive benefit from chiropractic treatment, but how about chiropractic care to treat cancer or infertility? Aroma therapy? Faith healing.

Then there is the problem of therapy that is scientifically efficacious but ruinously expensive. Should a reformed healthcare system guarantee access to all for those therapies?

The most logical, and therefore less emotionally appealing approaches is to only allow therapies that have been scientifically demonstrated to be cost effective, with cost effectiveness measured against the cost per year of life saved in hemodialysis patients. This would solve a lot of problems. Quack therpies would not be cost effective because they are not effective at all. The same would apply to demonstrably futile therapies, such a transplants in end stage cancer patients. There would be a competetive pressure to make therapies more efficient, and reach the cost-effectiveness threshhold. Non-cost effective therapies would still be available, but the healthcare system would have no obligation to provide them.