Health Insurance Reform In The USA—What, How, And Why?

Source: Theodore Joyce, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018

The U.S. Congress failed to repeal and replace the Affordable Care Act (ACA). Will the country limp along with a politically unsupported ACA or is this an opportunity for a serious discussion about health insurance reform in the United States? In this Point/Counterpoint, Adam Gaffney, a physician and instructor in Medicine at the Harvard Medical School and a member of the Cambridge Health Alliance, argues for a national insurance program that provides first-dollar coverage to all Americans. Dana Goldman, the Leonard D. Schaeffer Chair and distinguished Professor at the University of Southern California, and Kip Hagopian, co-founder of Brentwood Associates and Managing Partner at Apple Oaks Partners LLC, also argue for universal coverage, but one consistent with standard principles characteristic of automobile or home insurance. These widely differing approaches to health insurance reform could not be more timely or more cogently argued.

Related:

It Is Time For Universal Coverage Without Breaking The Bank
Source: Dana P. Goldman and Kip Hagopian, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018

….So what can be done now that “repeal and replace” has failed? There is a call for bipartisan solutions, but proposals are often short on details. What specifics we do get involve modest reforms to reduce cost-sharing and stabilize the existing markets. This is not enough; we need fundamental reform, and five goals should undergird a bipartisan plan:
• make coverage universal and progressive;
• build on, but do not replace, the private insurance system;
• keep it affordable and sustainable; reduce incentives for adverse selection (avoidance of bad health risks); and
• create incentives for prevention and long-term investment…..

Health Insurance Reform In The United States—What, How, And Why?
Source: Adam Gaffney, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018

Last summer, Republican efforts to repeal the Affordable Care Act (ACA)—seven-years in the making—dramatically collapsed. Yet, if the failed Senate vote in July marked a pause in conservative reform efforts, it only further animated the health care reform debate on the left side of the political spectrum.

In this article, I argue that one of the reform models under discussion—single-payer national health insurance (NHI)—is the most potent and realistic policy solution. First, I make the case that universal coverage is economically feasible. Second, I examine why achieving universal coverage remains paramount. Third, I describe how universal coverage can be quickly and effectively achieved via NHI enrollment. Fourth, I discuss benefit design, emphasizing the importance of comprehensive benefits, and first-dollar coverage. And finally, I explore the role of the public and private sectors, arguing that health care coverage must remain entirely within the public sphere if the goal of universal health care is to be, at long last, attained…..

Medicare-For-All: Not Our Only Option For Universal Coverage
Source: Dana P. Goldman and Kip Hagopian, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018

The failure to meet ambitious but attainable goals—cover everyone, control costs—has created opportunity for radical reform. Dr. Gaffney advocates for universal health coverage via the burgeoning “Medicare-for-All” approach that has dominated the progressive health reform landscape for decades. As appealing as it may be from the outside, the strategy ignores several key health policy realities, namely the proper amount of insurance, the historic limitations of Medicare, the pitfalls of cutting costs by reducing administration, and the rising pressure of private markets in international health insurance…..

Universal Underinsurance Is Not The Same As Universal Health Care
Source: Adam Gaffney, Journal of Policy Analysis and Management, Volume 37, Issue 1, Winter 2018

I begin my response to Dana Goldman and Kip Hagopian’s admirably clear reform proposal on a point of agreement. Today, 28 million Americans remain uninsured according to the United States Census Bureau. The three of us clearly agree that this status quo is unacceptable, and that universal coverage is attainable, affordable, and right.

Beyond that, however, it becomes clear that we have very different visions for the future of American health care……