Higher value makes it more difficult to limit increased costs .
Higher costs bring increased controls by payers.
Private insurance market has strong incentives to avoid coverage of those needing most care. Thus conflicting interests are elderly v. elderly rather than young v. elderly 9. Also means less generous employee benefits as there is less competition for employees. Skimming by the insurance industry concentrates spending in Federal government programs. But the present, and most likely near future, incremental approach has both government and private insurance considering shifts from defined benefit plans to defined contribution plans .