Solving U.S. health insurance problems is ‘actually very simple,’ says leading economist

FFixing America’s health care system may seem like a Herculean task. But the solution is actually very simple, according to Amy Finkelstein, an economist at the Massachusetts Institute of Technology.

In their recent book Weve Got You Covered: Rebooting American Health Care, Finkelstein and Stanford economist Liran Einav describe how years of research led them to the conclusion that the best path forward is for the United States to offer coverage. universal basic health care.

Speaking at the STAT Summit in Boston last week, Finkelstein explained that the reality of the current U.S. healthcare system is that taxpayers already end up footing the bill when people are unable to afford the costs of their medical treatment.

We’re already paying as taxpayers for universal basic automatic coverage, but we’re just not getting it, Finkelstein told STAT reporter Bob Herman at the summit. You might as well formalize and finance this commitment from the start.

She said basic health coverage, which can be provided by a single payer or by a multiplicity of private payers, depending on the policy design, could be provided automatically to all Americans, without raising taxes. In the United States, half of our health care costs are funded by taxpayers. If we add it all up, it represents 9% of GDP. That’s as much as other countries spend on universal health care, Finkelstein said.

The system she proposes would also not involve co-pays or deductibles. Long touted by health economists (including Finkelstein) as the antidote to unnecessary reliance on health care by forcing people to put their financial skin on the line, more recent research has shown that because countries end up granting exemptions to a wide range of people living in poverty For the elderly, students, people with disabilities and those undergoing cancer treatments, they end up creating more complications than benefits.

Finkelstein and Einav no longer view co-pays and deductibles as effective tools for reducing costs. We’re taking it back, at least in the context of the universal core elements of the program, Finkelstein said.

This would not leave anyone without insurance and would eliminate the stress of losing coverage, which is a possibility even for people who have insurance.

The key word in this plan is fundamental, Finkelstein explained. The universal option would not cover all services, but only essential services, as is the case in most countries with universal coverage. This is crucial for Finkelstein and Einav’s proposal to be sustainable.

Of course we would all like a private hospital room. We would all like to see the doctor tomorrow. But we believe that this is not part of the social contract on what is truly essential. she says.

Countries, however, are divided on what constitutes basic services. There are services that are clearly fundamental (e.g. vaccines, primary care, cancer care, maternity care) and others that are absolutely not (e.g. purely cosmetic plastic surgery). But Finkelstein noted that many services fall into a gray area, such as physical therapy, new medications that only extend life expectancy by a few months, Viagra and in vitro fertilization.

Determining which categories the latter group of services falls into will be a matter for political debate, Finkelstein said. This is not a one-time decision. It will be a decision we continually have to make as incomes rise, new medical technologies are created and notions of disease evolve, she said.

When people want services that aren’t basic, Finkelstein said, the best option is to allow people who can and want to supplement that basic floor through a well-functioning supplemental insurance marketplace. designed.

But while the plan may seem simple, mustering the political will to implement it can be a more complicated proposition. I’m pretty sure that won’t happen this week, we need to find a speaker first! she said, referring to ongoing efforts to elect a new House speaker. On a more serious note, she said: Policy windows open unexpectedly every time we want to be ready when that window opens.

Whether through one big reform or a series of incremental reforms over the years, Finkelstein is confident that her and Einav’s vision can gain momentum. I am full of hope, she said.