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Opinion | The Ethical Mess of Our Health Care System

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Whether or not the administration succeeds, our health care system will remain sorely lacking in basic justice and economic efficiency. It is a system that too often creates perverse incentives favoring the overtreatment of diseases. To avoid this, we must start treating sick people fairly.

Such a path exists: Rather than repeal and replace the A.C.A., we need to revise and reinforce it. With about 90 percent of Americans now covered by health insurance, the A.C.A. was highly successful in improving our irrational system by expanding coverage for effective treatments while also reining in some spending.

That does not mean the law could not be improved by, for instance, reducing the high costs of drugs, co-pays and deductibles. But instead of calling for improvements, Republicans and now even many Democrats are threatening to dismember the law. That would be a tragic mistake when there is nothing close to a consensus on how to replace it.

There are multiple ways to achieve the worthy, non-utopian goal of reducing the uneven, crazily complicated nature of health care coverage, which has contributed to Americans’ having among the lowest life expectancies and highest infant mortality rate of any affluent nation. Reinforcements to the A.C.A. should include a voluntary public option — “Medicare for more” — that would coexist with common-sense improvements to the private employer-based coverage enjoyed by roughly 160 million Americans.

There’s also an economic and an ethical imperative for employers to improve prevention. They can use their leverage with private insurers to insist on health plan performance metrics and innovations like digitally based care systems that track medical problems before they become dangerous.

By revising and reinforcing the A.C.A., we can benefit all Americans without threatening any with the loss of hard-fought, lifesaving health coverage. Surely our fellow Americans with life-threatening diseases of all sorts are also worth saving.

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Amy Gutmann is the president of the University of Pennsylvania, where Jonathan D. Moreno is a professor of bioethics. They are authors of the forthcoming “Everybody Wants to Go to Heaven but Nobody Wants to Die: Bioethics and the Transformation of Health Care in America.”

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