Summary: We have referenced the founders of the American republic several times in this volume. Why did their work survive? Why did it do so well? To understand their choices, you must understand their reasons and their principles. At heart, they were “idea politicians” who applied principles to the task of establishing right incentives for government. There is a lesson here. Without referencing principles, the debate over health care degenerates into nothing more than a jumble of conflicting attitudes and opinions.

Variation regarding flexible implementation details notwithstanding, there is a virtually unique way to influence the economy to accomplish universal health insurance coverage that satisfies the objectives of Chapter 2, avoids the pitfalls of Chapter 3, and applies the principles of Chapter 3. Collected from the work of many others, with additions of our own, the implied structures incorporate and align incentives for an effective, sustainable health care system.

We are not the first to note that American health care has drifted into a wrong way of doing things that increasingly ignores economic principles. It needs answers to get back on track, but to get the right answers one needs to ask the right questions.