For many in the United States, healthcare reform has become such a hot topic that it’s almost untouchable. Still, that hasn’t stopped a growing number of pundits from trying to handle public perceptions of the issue. There is an increasing sense among the American public that what used to be a conversation between parties with different values is now a zero-sum game.

Healthcare costs are reaching a critical stage and that they will endanger the entire economy and the health of everyone unless the country addresses them soon. Facts and figures have given way to buzzwords, and ad hominem attacks as elected representatives pander to constituents instead of looking at measurable information. Still, the frustration of everyday Americans is being heard by some who can influence the conversation at higher levels.

It is time for a different approach to healthcare and calls for more rational discourse on the subject. Instead of focusing on ideal outcomes, healthcare leaders and politicians need to encourage the public to take a measured and considered approach to the problem by examining the current state of things and using available resources. One of the key areas is cost. Looking at the financial realities of healthcare in America is the best way to create responsible changes that will last, having a net positive benefit for the country.

Of course, it’s difficult to talk about healthcare reform in the US without addressing the Affordable Care Act. The ACA is a subject that has become even more contentious than usual in recent months, as Republicans rush to implement their new healthcare bill. Many on the right of the political spectrum view “Obamacare” as a step towards a socialist single-payer healthcare system, but the ACA has its detractors on the left, too. Many liberals and socialists feel that Obamacare is a move in the right direction, but that it is ultimately ineffectual. They claim that the ACA is not adequately funded or organized, resulting in a half-measure that greatly inconveniences many Americans by placing unreasonable financial burdens on them to support other users.

Six of One, Half a Dozen of the Other

If we take both arguments into consideration then we can see that each one has valid points. A top-down federal solution will not work politicians do not have the freedom to exercise the political will to do it. We also cannot make major reforms that would move the country towards universal care. We should be wary of single-payer systems which would be ruinously unworkable in the United States. Care is readily available in large, well-developed single-payer countries like Canada and the United Kingdom, big procedures come with long waits. America’s demographics and population size means that a single-payer system would create a new entitlement that we could never support.

How Insurance Reform Can Affect Healthcare Premiums at Different Levels

Instead of focusing on a complete overhaul of the system we should start with comparatively slight changes could have major effects. One of these areas is insurance reform, which is a viable way to reduce premiums for middle-class earners. Having limited access to different options for private insurance results in certain earners being forced to pay higher premiums. These premiums are usually higher because they help subsidize care for other segments of the population who are in vulnerable positions or lower income brackets. Such groups might include low-income families, disabled people or retirees. If middle-class earners have access to other insurance markets including across state lines. In this way, they can avoid paying for the care of people in these demographics.

While there’s an argument to be made for lowering middle income premiums with insurance reform, such a solution raises fundamental questions.

This leaves the problem of how the people who rely on middle-income subsidies to fund their medical care would access adequate treatment. The answer is for individuals to manage their own healthcare through reasonable lifestyle choices and ensuring the incentives are structured right.

Unhealthy people are subsidized at the expense of the healthy. Imposing limitations for self-destructive personal choices will prevent people from putting too much strain on the healthcare system and free up resources for people who need them more urgently. This means actively using policy to raise the cost for smoking, obesity, and sedentary lifestyles.

We need to be cautious when allocating resources like current medical technology and procedures for terminal patients. People are living too long and healthcare costs are too high to handle all the catastrophic costs that terminal patients can run up. Instead of using resources on people who won’t live we can value human life most by respecting when it cannot reasonably be extended. Since most medical expenditures are incurred during the last six years of a person’s life this will free up significant amounts of capital, equipment, and time for people like transplant patients who need organs and will recover. We just cannot afford unlimited care for everyone in all circumstances.

A Time for Tough Choices?

These views are controversial but necessary to help Americans face the truths about healthcare. Some of the changes will be painful and unpopular but they are necessary for getting the situation under control.