Ezekiel J. Emanuel and Victor R. Fuchs write,
[Most health care reform plans] prop up the sagging employment-based insurance system, with all its inefficiencies and inequities, and preserve the second-class income-tested programs such as Medicaid...
The country needs comprehensive reform. Here are five essential changes:
· Get businesses out of health care...
· Guarantee every American an essential benefits package. This package -- modeled on what members of Congress get -- should be provided by qualified plans that would receive a risk-adjusted payment for each enrollee...
· The universal basic package should be financed by a dedicated tax that everyone pays, such as a value-added tax.
· Administer the program through an independent National Health Board...
· Establish an independent Institute for Technology and Outcomes Assessment to systematically evaluate new technologies and quantify their health benefits in relation to their costs.
I agree with the first idea of getting rid of employer-provided health insurance. I agree with the last idea, of conducting and disseminating research on cost-effectiveness.
However, Emanuel and Fuchs sound as though they are trying to provide equal health care to everyone. While I think that everyone could be given a decent "floor" in terms of health care, I do not see how it would be possible or desirable to enforce a ceiling as well. We are not going to shut down Canyon Ranch Health Spa, nor are we going to make it available to everyone. Inequality in health care is a reality that we will need to accept.
SHARE