Models for the future of healthcare in the U.S. can be arrayed along a continuum with two very different end points. On one end, healthcare becomes a market good with access based on ability to pay, and on the other hand it is recognized as a societal right with access provided without regard to ability to pay. Regardless of where our society finally ends up on the continuum, the creation of a national health information network (NHIN) is a fundamental necessity.

The debate about who is going to pay for it is far from over, but there is no debate about whether or not substantial benefits can be derived from such an implementation. The benefits to be derived from disease management and population health improvements can play a valuable role in building the case for investment in an NHIN. Conversely, our ability to predict, prevent and manage disease is greatly hampered in the absence of such a network.

The Healthcare Model: Market Good or Societal Right?

The market good and consumer accountability model states that insurance coverage must be coupled with significant personal contributions so as to control “moral hazard” (see box). According to this model, personal accountability for one’s health status and for cost sharing based on one’s own usage of the system is the best option. This is an actuarial view of insurance, where people pay into the system in proportion to what they use. Proponents of this model argue that the current system is more like social insurance. The social insurance model is viewed, at this end of the continuum, as a model that penalizes the healthy–and serves as a crushing tax on those who are well.

This point of view is based on the assumption that a lack of personal accountability for costs incurred raises moral hazard to unacceptable levels. Left unchanged, it is argued, the current system will result in more chronic conditions and cause healthcare costs to rise to unacceptable levels. This would place the U.S. economy at a considerable disadvantage relative to the rest of the industrialized world.