healthier individuals to help poorer or sicker individuals, the virtues of voluntary versus compulsory insurance, the role of the private versus the public sector in ensuring access to needed health care, and the effectiveness of market versus regulatory strategies to contain costs and ensure value. For some, the conclusion is that market forces are not being allowed to work and need to be strengthened by various regulatory changes (hence the term regulated or managed competition). Others conclude that market forces have not worked and cannot work given the nature of health care and health insurance and that existing market structures should therefore be replaced in part or whole by public programs of various sorts. For all, the current, central position of employment-based health benefits is a major factor to be reckoned with in considering the feasibility and specifics of proposals for health care reform.

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