This alternative view presents a comment on Philip Musgrove's chapter 6 in this volume. I essentially reaffirm Musgrove's proposal for four priority interventions: improving healthcare access, healthcare quality, healthcare efficiency, and healthcare-seeking behaviors. However, I both depart from and complement the chapter in four ways:

• First, shifting the solution from the disease-specific focus of the 2004 Copenhagen Consensus process to the system focus of the Consulta de San José 2007 is justified by the specific epidemiology and resources of the region.

• Second, increasing health insurance coverage is not the only or best way to expand access to healthcare in the region. The public sector may be able to expand coverage through other demand-side alternatives, such as public purchasing of healthcare for the population. Furthermore, some governments have successfully expanded publicly provided services – usually with innovative payment mechanisms – in supply-side approaches which may be feasible and less costly.

• Third, while Musgrove correctly rejects calculating a specific BCR on firm technical and ethical grounds, there are competing ethical concerns for this specific process that call for such calculations, despite the shaky empirical foundations.

• Finally, additional solutions that require actions outside the healthcare sector, such as addressing alcohol abuse and tobacco addiction, should not be forgotten.