Controlling health care costs is thefundamental domestic policy challenge facing the United States. Increasing health care costs reduce state funding for education, especially public colleges and universities, raising tuition costs and student indebtedness.1 Increasing health care costs constrain middleclasswages as increases in productivity are siphoned off to fund health insurance rather than take-homepay.2 Increasing health care costs account for a large part of the federal budget deficit and are the fundamental driver of the United States’ longterm debt.

Ezekiel J. Emanuel,MD, PhD; Andrew Steinmetz, BA