The intersection of the presidential election and the COVID-19 pandemic is likely to make health care reform a frequent subject of conversation in the coming months. Yet for many voters, the proposals and their implications remain hard to decipher, whether in typical years or in the midst of economic crisis. This paper describes the central issues at the heart of current health care reform proposals, with a focus on understanding that each proposal requires society to make difficult choices and appreciating the trade-offs of each choice.

Evaluating the trade-offs inherent in the answers to each of five core questions is critical to understanding the philosophical underpinnings and general implications of health reform proposals.

1. How broadly should the costs of the sick be shared with the healthy?
2. How important is reaching true universal coverage? How many US residents must be insured?
3. How generous should federally financed subsidies of premiums and cost sharing be?
4. How should reform options be financed?
5. Should there be regulations limiting the prices paid to health care providers of different types (i.e., hospitals, physicians, prescription drug manufacturers, medical device manufacturers), and if so, how broadly should those regulations apply, and how should prices be set?

This analysis addresses the significance of each of these questions and the trade-offs inherent in different answers. It then walks the reader through the answers to each of the core questions for three prominent reform proposals:

• Full repeal of the ACA
• Build upon the ACA with additional financial assistance and a public option
• Replace the current system with an enhanced single-payer program