ABSTRACT:

Karen Davis and Cathy Schoen offer a strategic vision for universal coverage that attempts to move beyond ideological battles that have stifled progress. However, I believe that there are a few specific shortcomings with the proposal's logic that could thwart political consensus. I review some of these shortcomings and make suggestions for incremental technical improvements. In particular, I suggest that future versions of the proposal consider administering the tax credits as a "passthrough" from the government through employers to individuals. I also believe that reform proposals should address more directly the issues of provider accountability and patient information needs.

Proponents of universal health care coverage are finally homing in on realistic solutions. For decades, we've searched for "big bang" comprehensive health reforms: state-based single-payer programs, Medicare for all, sweeping employer mandates, and tax credits for individual insurance. However, none of these proposals achieved broad political support. Each was too disruptive to consider seriously; none could survive a fundamental clash of ideologies.

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Call it strategic incrementalism, or practical idealism, but it's an important development. Davis and Schoen are correct on several possible components of an ideologically neutral design: (1) an individual mandate, (2) public funding for private coverage through refundable tax credits, (3) subsidized group pooling systems, (4) transitional coverage for the unemployed, (5) easy enrollment, and (6) government programs to fill in the cracks.

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Read the entire article on the Health Affairs' website: www.healthaffairs.org/WebExclusives/
Lemieux_Web_Excl_042303.htm

Jeff Lemieux is the senior economist at the Progressive Policy Institute