Friday, April 02, 2004
The many obstacles in the way of universal health coverage
[Joseph P. Newhouse and Robert D. Reischauer, "The Institute Of Medicine Committee’s Clarion Call For Universal Coverage," Health Affairs, 31 March 2004.]
As it turns out, transitioning to a universal health care system in the U.S. might be a tad more complicated, not to mention expensive, than its proponents suggest:
The Institute of Medicine (IOM) Committee on the Consequences of Being Uninsured is to be commended for its work, which recently culminated in the release of six volumes on the subject. The concluding volume presents a vision for universal coverage and describes four options for achieving it. The options include an incremental approach, employer and individual mandates, and a single-payer plan. We identify complications involving benefits and geographic variation in costs surrounding attempts to achieve universal coverage. The complications suggest that the committee’s cost estimates may be too low and that there may be sizable political barriers to the proposals.
Any universal insurance plan will increase the amount of redistribution from the healthy to the sick, from higher-income to lower-income households, across workers at different firms and possibly within a firm according to their current health benefits, and between owners of different businesses. Ultimately, of course, it is all redistribution across households.
With personal health care services constituting more than one-eighth of the economy, the scope of potential redistribution is large—larger than any non-wartime policy change we can think of, save Social Security. The U.S. political system tends to resist increased redistribution, particularly when it creates identifiable losers...
[Joseph P. Newhouse and Robert D. Reischauer, "The Institute Of Medicine Committee’s Clarion Call For Universal Coverage," Health Affairs, 31 March 2004.]
As it turns out, transitioning to a universal health care system in the U.S. might be a tad more complicated, not to mention expensive, than its proponents suggest:
The Institute of Medicine (IOM) Committee on the Consequences of Being Uninsured is to be commended for its work, which recently culminated in the release of six volumes on the subject. The concluding volume presents a vision for universal coverage and describes four options for achieving it. The options include an incremental approach, employer and individual mandates, and a single-payer plan. We identify complications involving benefits and geographic variation in costs surrounding attempts to achieve universal coverage. The complications suggest that the committee’s cost estimates may be too low and that there may be sizable political barriers to the proposals.
Any universal insurance plan will increase the amount of redistribution from the healthy to the sick, from higher-income to lower-income households, across workers at different firms and possibly within a firm according to their current health benefits, and between owners of different businesses. Ultimately, of course, it is all redistribution across households.
With personal health care services constituting more than one-eighth of the economy, the scope of potential redistribution is large—larger than any non-wartime policy change we can think of, save Social Security. The U.S. political system tends to resist increased redistribution, particularly when it creates identifiable losers...
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