The Iron Triangle

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Three goals that fight each other

Every health system is trying to do three things at once: make care cheap, get it to everyone, and make it good. The catch is that the three pull against each other.

Cover more people and the bill climbs. Cap the spending and you get longer waits or thinner care. Chase the best outcomes and the price goes up again. Push on any one corner and the other two strain. That is the iron triangle, and no country escapes it. They just choose which corner to protect.

The United States is the odd one that trails on all three at once, which is the thread running through everything here. So there is no free win, only a choice about which corner to push on first.