The most common forms of cost sharing are: deductibles (an amount that must be paid before most services are covered by the plan), copayments (fixed dollar amounts), and coinsurance (a percentage of the charge for services). Sometimes cost sharing forms are mixed, such as assessing coinsurance for a service up to a maximum amount, or assessing coinsurance or copayment for a service, whichever is higher. The type and level of cost sharing often vary by the type of plan in which the worker is enrolled. Cost sharing may also vary by the type of service, such as office visits, hospitalizations, or prescription drugs…. Some plans require enrollees to meet a service-specific deductible, such as for prescription drugs or hospital admissions, in lieu or in addition to a general annual deductible.

Indeed, the “cost” angle has dominated the iron triangle for attention in most decades since.

The logic behind the association depicted in the curve is straightforward. Increased societal wealth can be channeled to greater investments in education, housing, nutrition, and public health, as well as purchases of health insurance and healthcare services that improve health status and longevity.

We have never covered the entire population for a comprehensive set of services, and even among the highest-income population, insufficient care was the rule.

The problems we face today, which lead commentators to claim our healthcare system is broken, are the same problems we faced at least a century ago.