National health insurance: comments on selected issues

The primary objective of national health insurance is to make sure that good medical care is available to everyone at a price he or she can afford. Any plan when first adopted will have a role for both private and government insurance but, regardless of the mix, the combined system should meet the following goals: (i) to the extent possible the needs of low-income people should be met through plans that cover others; (ii) the part of the plan to be operated by government should be built on the administrative structure of Medicare, but with changes in reimbursement to encourage more efficient delivery of care; (iii) direct capital and manpower controls should be included; and (iv) rather than acting primarily as an insurer protecting people against the cost of medical care, the plan should be an aggressive buyer of health services, defining the product it is willing to buy and the price it is willing to pay.