|
Principles |
Status Quo (Current U.S. Health Care
System) |
Prototype 1:
Major Public Program Expansion and Tax Credit |
Prototype 2:
Employer Mandate, Premium Subsidy, and Individual Mandate |
Prototype 3: Individual Mandate and
Tax Credit |
Prototype 4: Single Payer |
| Coverage should be universal |
Not universal; 43 million uninsured |
Would not achieve universality because voluntary, but would
reduce uninsured population |
Coverage likely to be high: depends on enforcement of mandates |
Depends on size of tax credit, enforcement, and cost of
individual insurance |
Likely to achieve universal coverage |
| Coverage should be continuous |
Not continuous; income, age, family, job, and health-related
gaps in coverage |
Family and job-related gaps in coverage |
Brief gaps related to life and job transitions |
Minimal gaps |
Continuous until death or age 65 |
| Coverage should be affordable for individuals and families |
Private coverage unaffordable to many moderate- and low-income
persons |
More affordable than current system for those with low
or moderate income |
Yes for workers, assuming adequate employer premium assistance;
public program designed to be affordable for all enrollees |
Subsidy based only on income and family size leaves older, less
healthy, and those in expensive areas with less affordable coverage |
Minimal cost sharing, but could be problem for lowest
income |
| Strategy should be affordable and sustainable for society |
Not affordable or sustainable for society |
All participants contribute; aggregate expenditures not controlled;
new public expenditures for only the public program expansion and
tax credit; sustainability of public program depends on revenue
sources and political support; size of credit depends on political
support |
All participants contribute; basic package less costly than
current employment coverage; revenue from patients in public
program; sustainability depends on revenue sources for employers’
premium assistance and public program |
No limit on aggregate health expenditures or on tax expenditure,
though federal costs relatively predictable and controllable through
size of credit; sustainable through federal income tax base;
size of credit depends on political support |
Nearly all participants contribute; aggregate expenditures controllable,
utilization not directly or centrally controlled; high cost to
federal budget; administrative savings; sustainability depends
on revenue source and political support. |
| Coverage should enhance health through high-quality care |
Quality of care for the population limited because
one in seven is uninsured |
Opportunities to promote quality improvements similar to current
system |
Could design quality incentives in expended public program
and basic benefit package; current employer incentives for quality
remain |
Similar incentives to current private insurance system;
consumer could choose quality plans
|
Potentially yes; depends on proper design |
| Source Reprinted with permission from (Insuring America's
Health: Principles and Recommendations) © 2004 by the National
Academy of Sciences, courtesy of the National Academies Press, Washington,
D.C. |