Radical Health Care Reform

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.

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.