There are a few principles that should govern healthcare policy-making:
1.) The fundamental characteristic of a sustainable healthcare system is not compassion, or comprehensiveness, or justice, or equality, or cost effectiveness. It is predictability. Predictability is why we have written laws it is the characteristic that allows engineers to design aircraft and computers, and chemists to develop new pharmaceuticals. Predictability is what allows actuarial analysis and rational assessment of risk. Predictability is what allows people to make plans with a reasonable expectation of favorable outcomes. The first step in formulating a sustainable healthcare policy is to excise as much caprice, and uncertainty as possible.
2.) Healthcare policy does not determine who gets care, it determines who gets rich. In point of fact there is almost no one in this country who does not have access to at least least some healthcare. It may be inefficient; it may not be cost effective and it may not be particularly thoughtful, but no one need die of tuberculosis or typhus or beri-beri unless psycho-social factors intervene. The future of healthcare as asocial asset will be determined more by technology and the principles of economics; the future of healthcare as an industry will be determined by regulation and policy.
3.) The Pareto principle applies to healthcare: 80 % of the care can be delivered for 20% of the cost.
4.) All systems of benefits and resource allocation become multi-tiered. There is a multi-tiered educational system in this, and every country. There is a multi-tiered judicial system. there is a multi-tiered public health system and a mult-tiered infrastructure system. It does not matter if policy prescribes a single payer system, some sort of hybrid, or a totally market-based system, it will be multi-tiered. This is not the avoidable result of corruption or malign intent on the part of policy makers, although that will certainly make matters worse. It is rather the result of the uneven distribution of inherent advantages and disadvantages, tangible and intangible, across any sizable group of people.
5.) The next big revolution in healthcare will be probabilistic medicine driven by enormous strides in data processing. the cognitive aspects of computers will yield to a significant degree to massive decision algorithms that incorporate huge volumes of data from tens of millions of patients.