Description: Essay discussing cost, quality and access of healthcare and then describes the need for rationing.

Description: This article is the second in a two part series that summarizes a longer paper that can be downloaded from the website of the Social Insurance and Public Finance Section. Both articles take the form of a point-counterpoint dialogue addressing important aspects of social insurance programs. The first part discussed their nature, desirability and advantages, as well as whether they can form a framework to achieve sustainable inter-generational equity. This article focuses on whether pre-funding of a social insurance program can occur and can contribute to the financial security of the participants. Fundamental differences of opinion exist regarding these programs, not only due to different personal and political values, but also as a result of the viewpoint taken (for example, assessment of the program in isolation, consideration of the sponsoring government's financial situation, or the overall national economy).