Despite the fact that the United States spends more of its gross domestic product on health care than do other countries, an estimated 16% of its population has no health insurance coverage. The author believes that a hybrid approach combining universal risk pools, required coverage with income-based subsidies, and a restructured payment system would be able to provide more equitable health care more efficiently. Medicare stands as the prototypical single-payer model, but only an approach that assures universality while minimizing political interference will succeed.
If attention is focused on patient outcomes, clinicians and hospitals could explore ways of delivering care while eliminating the present emphasis on fee constraints and the micromanagement of clinical decisions. A simplified system would eliminate unneeded administrative costs. Market-disciplined carriers would facilitate payment, provide information, and attend to patient preferences. Finally, appropriate incentives would enable informed patient and clinician decision-making about the care needed to obtain high-quality outcomes.
Institute for Health Policy Studies, University of California, San Francisco