Health Reform: Two Views from Health Affairs

Continuing its role as one of a handful of "must-read" publications in the health care field, Health Affairs' November/December issue is filled with valuable articles on health reform.  Here's a sampling:

• Health Care Reform: Why? What? When?
  Victor R. Fuchs and Ezekiel J. Emanuel
  Dissatisfaction with the U.S. health care system is widespread, but no consensus has emerged as to how to reform it. The principal methods of finance—employer-based insurance, means-tested insurance, and Medicare—are deeply and irreparably flawed. Policymakers confront two fundamental questions: Should reform be incremental or comprehensive? And should priority be given to reforming the financing system or to improving organization and delivery? We consider here several proposals for incremental reform and three for comprehensive reform: individual mandates with subsidies, single payer, and universal vouchers. Over the long term, reform is likely to come in response to a major war, depression, or large-scale civil unrest.
• Whence And Whither Health Insurance? A Revisionist History
  Donald W. Moran
  Throughout the postwar era in federal health policy, policymakers have sought to expand both public and private insurance coverage, while wrestling with the cost consequences of the demand generated by the insurance-financing mechanisms thus created. This essay advances the view that the limits to insurance expansion have been reached and that public and private plan sponsors will henceforth continually "thin out" the coverage they offer. In this environment, policymakers seeking to mitigate access concerns may need to consider strategies that promote direct service delivery. This emerging regime, it is argued, will have important implications for the future of innovation in health care.
• The Political Divide In Health Care: A Liberal Perspective
  Thomas Bodenheimer
  U.S. health policy has been consumed by an ideological divide between conservative and liberal viewpoints. The liberal philosophy, based on both moral principles and utilitarian arguments, attempts to balance the needs of the individual with the concerns of the entire population. Elements of the liberal health care perspective include a belief that health care is an equal right of all people, the implementation of that right through a social insurance system that provides universal health coverage, equitable financing of health care, and a commitment to equality in health care.

There are a lot of other articles in this issue, especially on consumer-driven market competition, that are well worth reading.  [tm]