That is the title of this paper, in which I trace the history, politics, and economics of our health care system The bottom line:

The health care reforms that were debated in 2009 and 2010 did not address the fundamental choices that America must eventually face. As heated as the debate became, the proposed changes were only superficial. Down the road, the choices will be more difficult. At some point, we either have to impose stronger rationing of care by the government or we have to force individuals to confront more of the cost of their own care, perhaps using a voucher system to fund health spending.