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But that outcome is not certain. A major war, a depression, or large-scale civil unrest might well set in motion a change in the political climate that would overpower the obstacles that prevail in normal times. One economic rationale for employer mandates is that the cost of care for uninsured workers is often passed along to the insured through taxes and other mechanisms. For instance, Jeanne Lambrew and colleagues estimate that their reform proposal would require $100–$160 billion per year. The advantage lies in simplicity of plan design and the likelihood that no large groups would believe that they had been hurt by the reform. Even if as much as two-thirds of the public were dissatisfied with the present system, that would leave a sizable minority who do not want any reform. The way health information technology is developed, the way it is implemented and the way it is used are what matter.” A common goal of all comprehensive reform proposals is universal coverage, providing every American with health insurance.
Without increased efficiency, overall health spending would be likely to shoot up.
Medicare expenditures are difficult to predict or control. As Machiavelli, one of the shrewdest political analysts of all time, noted, “There is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things.
They may agree that there are problems with the current system with regard to cost or access or quality of care, or even all three, but at least the problems are known. Ever since World War II, the cornerstone of U.S. health care finance has been employer-based insurance. Today most beneficiaries of employer-based insurance are in plans in which the firms are self-insured or are experience-rated (which means that they are self-insured with a year lag). Or consider a sample of major social and economic changes that the United States has adopted over the past hundred years: the Federal Reserve System, Social Security, civil rights, and protection of the environment. What kind of reimbursement system would reward efficiency and cost-effective care without creating incentives for stinting and adverse selection? But that would be a mistake.
814 September 2006 | Health Affairs, Vol.
The fact that mandates with subsidies would build on existing systems of finance, organization, and delivery is perceived as an advantage by some and as a disadvantage by others. Freeman, Richard. Enter your email address below and we will send you the reset instructionsIf the address matches an existing account you will receive an email with instructions to reset your password.Enter your email address below and we will send you your usernameIf the address matches an existing account you will receive an email with instructions to retrieve your usernameDissatisfaction with the U.S. health care system is widespread, but no consensus has emerged as to how to reform it.
Firms that are below the specified minimum size that trigger the mandate could be discouraged from expanding or could resort to using more part-time or temporary workers to escape the mandate.
But that outcome is not certain. A major war, a depression, or large-scale civil unrest might well set in motion a change in the political climate that would overpower the obstacles that prevail in normal times. One economic rationale for employer mandates is that the cost of care for uninsured workers is often passed along to the insured through taxes and other mechanisms. For instance, Jeanne Lambrew and colleagues estimate that their reform proposal would require $100–$160 billion per year. The advantage lies in simplicity of plan design and the likelihood that no large groups would believe that they had been hurt by the reform. Even if as much as two-thirds of the public were dissatisfied with the present system, that would leave a sizable minority who do not want any reform. The way health information technology is developed, the way it is implemented and the way it is used are what matter.” A common goal of all comprehensive reform proposals is universal coverage, providing every American with health insurance.
Without increased efficiency, overall health spending would be likely to shoot up.
Medicare expenditures are difficult to predict or control. As Machiavelli, one of the shrewdest political analysts of all time, noted, “There is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things.
They may agree that there are problems with the current system with regard to cost or access or quality of care, or even all three, but at least the problems are known. Ever since World War II, the cornerstone of U.S. health care finance has been employer-based insurance. Today most beneficiaries of employer-based insurance are in plans in which the firms are self-insured or are experience-rated (which means that they are self-insured with a year lag). Or consider a sample of major social and economic changes that the United States has adopted over the past hundred years: the Federal Reserve System, Social Security, civil rights, and protection of the environment. What kind of reimbursement system would reward efficiency and cost-effective care without creating incentives for stinting and adverse selection? But that would be a mistake.
814 September 2006 | Health Affairs, Vol.
The fact that mandates with subsidies would build on existing systems of finance, organization, and delivery is perceived as an advantage by some and as a disadvantage by others. Freeman, Richard. Enter your email address below and we will send you the reset instructionsIf the address matches an existing account you will receive an email with instructions to reset your password.Enter your email address below and we will send you your usernameIf the address matches an existing account you will receive an email with instructions to retrieve your usernameDissatisfaction with the U.S. health care system is widespread, but no consensus has emerged as to how to reform it.
Firms that are below the specified minimum size that trigger the mandate could be discouraged from expanding or could resort to using more part-time or temporary workers to escape the mandate.