Health care reform: why? What? When?

Area of Science:

• Health Policy and Economics
• Healthcare System Reform
• Public Health Administration

Background:

• Significant public dissatisfaction exists regarding the current U.S. health care system.
• Existing financing methods, including employer-based insurance, means-tested insurance, and Medicare, are considered fundamentally flawed.
• There is no clear consensus on the optimal path for U.S. healthcare reform.

Purpose of the Study:

• To analyze the fundamental questions facing policymakers in U.S. healthcare reform.
• To evaluate various proposals for both incremental and comprehensive healthcare system reform.
• To consider the potential triggers for long-term, large-scale healthcare reform.

Main Methods:

• Review and analysis of existing U.S. healthcare financing mechanisms.
• Examination of proposed incremental reform strategies.
• Evaluation of three comprehensive reform models: individual mandates with subsidies, single payer, and universal vouchers.

Main Results:

• The principal methods of healthcare finance in the U.S. are identified as deeply flawed.
• Policymakers face a dichotomy between incremental versus comprehensive reform and financing versus organization/delivery priorities.
• Specific comprehensive reform proposals include individual mandates with subsidies, single payer, and universal vouchers.

Conclusions:

• The current U.S. healthcare financing system presents significant challenges requiring reform.
• Both incremental and comprehensive approaches to reform are under consideration, each with distinct policy implications.
• Long-term, transformative healthcare reform may be precipitated by major societal disruptions such as war, economic depression, or civil unrest.