Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-26T09:43:52.338Z Has data issue: false hasContentIssue false

Conflict and Compromise over Tradeoffs in Universal Health Insurance Plans

Published online by Cambridge University Press:  01 January 2021

Extract

Despite a consensus across the political spectrum that the problem of the chronically uninsured is in dire need of solution, little progress has heen made. Public spending goes to topping up coverage for the elderly, already heavily subsidized under Medicare, or helping people temporarily without insurance because of international trade dislocations, so that it is clear that something is lacking in the case for significantly reducing the number of uninsured persons. In this paper I suggest that there have been two missing ingredients: a strategy for breaking the political deadlock around this issue, and information about the benefits of coverage sufficient to persuade kindly but skeptical taxpayers that they should be willing to pay to help solve this problem.

This article begins with a discussion of these two problems. It then outlines a strategy based on income-related or conditioned refundable tax credits for private and public insurance, coupled with a plan to assemble persuasive information that may move things forward.

Type
Symposium
Copyright
Copyright © American Society of Law, Medicine and Ethics 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Blendon, R. J., Benson, J. M., and DesRoches, C. M., “Americans’ Views OfThe Uninsured: An Era For Hybrid Proposals,” Health Affairs Web Exclusive (August 27, 2003), at <http://content.healthaffairs.org/cgi/content/full/hlthaff.w3.405v1/DC1> (last visited July 2, 2004).CrossRef+(last+visited+July+2,+2004).>Google Scholar
Cogan, J.F., Hubbard, R.G., and Kessler, D.P., “Healthy, Wealthy and Wise,” Wall Street Journal, May 4, 2004, at A20.Google Scholar
Palmisano, D.J., Emmons, D.W., and Wozniak, G.D., “Expanding Insurance Coverage Through Tax Credits, Consumer Choice, and Market Enhancements,” JAMA 291, no. 18 (2004): 22372242; The Physicians’ Working Group for Single-Payer National Health Insurance, “Proposal of the Working Group for Single-Payer National Health Insurance,” JAMA 290, no. 6 (2003): 798–805.CrossRefGoogle Scholar
Glied, S., Chronic Condition: Why Health Reform Fails (Cambridge: Harvard University Press, 1997).Google Scholar
Black, D., The Theory of Committees and Elections (Cambridge: Cambridge University Press, 1958).Google Scholar
Alter, D.A., Iron, K., Austin, P.C., and Naylor, C.D., “Socioeconomic Status, Service Patterns, and Perceptions of Care Among Survivors of Acute Myocardial Infarction in Canada,” JAMA 291, no. 9 (2004): 11001107.CrossRefGoogle Scholar
“Insuring America’s Health: Principles and Recommendations,” Report of the Institute of Medicine Washington D.C.: National Academies Press, 2004).Google Scholar
Manning, W.G., Leibowitz, A., Goldberg, G.A., Rogers, W.H., and Newhouse, J.P., “A Controlled Trial of the Effect of a Prepaid Group Practice on the Utilization of Medical Services,” N. Engl. J. Med. 310, no. 23 (1984): 15051510.Google Scholar
For example, one could use the variation in insurance coverage associated with firm size as an “instrument,” or, in an experimental setting, give people different levels of insurance premium subsidies and examine both their insurance purchases and any difference in health between those assigned to “nearly free” insurance and those not offered subsidies.Google Scholar
Pauly, M.V. and Nichols, L.M., “The Non-Group Health Insurance Market: Short on Facts, Long on Opinions and Policy Disputes,” Health Affairs Web Exclusive (October 23, 2002), at <http://content.healthaffairs.org/cgi/content/full/hlthaff.w2.325v1/DC1> (last visited July 2, 2004).CrossRef+(last+visited+July+2,+2004).>Google Scholar
For more details, see Pauly, M.V., “An Adaptive Credit Plan for Covering the Uninsured,” in Wicks, E., ed., Covering America: Real Remedies for the Uninsured (Washington, D.C.: Economic and Social Research Institute, 2001): 137152.Google Scholar
See Pauly, , supra note 10.Google Scholar
Schatz, R., “Health Care in a Civil Society,” Letter to the Editor, New York Times, October 1, 2003, at A22; Goodman, M., “Health Care in a Civil Society,” Letter to the Editor, New York Times, October 1, 2003, at A22.Google Scholar
Fein, R., “Universal Health Insurance: Let the Debate Resume,” Journal of the American Medical Association 290, no. 6 (2003): 818820; See The Physicians’ Working Group, supra note 3.CrossRefGoogle Scholar