Toward a sustainable US health care system: Policy implications of market justice and social justice

The COVID-19 pandemic and current projections of rising health expenditures point to an impending sustainability crisis in US health care institutions, torn between competing demands of individualistic values (market justice) and collective values (social justice). Champions of individual responsibility are likely to favor a disease management model of health care – wherein the maintenance of lucrative food, medical, and pharmaceutical industries depends in large part on the creation and reproduction of an older but sicker consumer base, with survival to old age contingent on individuals’ capacity to pay for tests, treatments, and prescriptions. In contrast, proponents of community solidarity favor a health promotion model emphasizing primordial prevention – focused upstream on improvements in nutrition and in living and working conditions potentially capable of forestalling the onset of disease in the first place. In the end, health system sustainability will hinge on policy makers’ readiness to recognize, and innovate in response to, deeply ingrained values of both individual responsibility and community solidarity. To foster long-term stability in health care, effective policy must strive toward meeting the following essential needs: (1) optimal population health, (2) consumer and provider satisfaction, (3) fiscally stable and affordable funding sources, and (4) replacement opportunities for jobs lost to restructuring.