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Universal Coverage: A Bridge Too Far?

From Amichai D. Kilchevsky, About.com Guest

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Policies concerning the allocation of medical resources should be judged according to the criteria of efficiency in consumption, efficiency in production, and equity, specifically whether those with low incomes receive a net benefit. As the aforementioned examples have shown, market-based systems, in contrast to single-payer systems, have demonstrated their ability to achieve the goals of production and consumption efficiency. Moreover, providing subsidies to those with low incomes, as through a refundable tax credit, is a method of improving distribution equity that might be lacking in an unregulated free market.(14) Taxpayers would be allowed to subtract from their income tax the tax credit to purchase health insurance. Individuals whose tax credit exceeded their tax liabilities would receive a refund for the difference. If an individual's income were too low to pay taxes, the full amount of the credit would be used to provide him with a voucher. Data suggests that such tax credits could potentially provide a promising solution to the majority of the 40 million uninsured Americans.(15) Under such a market-based national health insurance system the rate of increase in medical expenditures would be based on what consumer decide is appropriate. Indeed, the government would not need to set arbitrary limits on total medical expenditures. Instead, the rate of increase in medical expenditures will more accurately reflect the priorities of consumers who, through their choices, will make the tradeoff between access to care and premiums to pay for that level of access.

The original American concept of freedom does not mean arbitrarily restricting an individual's access to medical treatment by bureaucratic entities in an ill-fated attempt to evenly distribute health care throughout the population. Nor does it mean the freedom to manipulate health care providers, taking by force their productive efforts. The moral foundation of United States is based on the principle of individual rights, which includes the rights of both the patient and the physician. Patients and physicians alike have the inalienable right to partake in and practice medicine on their own terms without the threat of loss of their right to life, liberty, and the pursuit of happiness. The physician-patient relationship is one based on the principle of mutually beneficial trade between a customer and the service-provider. This requires that the patient exercise his natural right to seek health care in accordance with his own best judgment. The moral foundation of this relationship is steeped in the free market principle of trading value for value. Free market reforms such as tax deductibility for medical expenses and insurance premiums offer Americans a practical and moral means of improving the health care system. The reliance on free market principles rather than on the government to distribute medical goods holds the promise of restoring the integrity of the health care system by improving the quality, costs, and availability of health care for all Americans.

Notes

(1)Epstein, Keith. (6/14/02). "Covering the Uninsured." The CQ Researcher Vol 12, No. 23. p. 521.

(2)Davis, Karen. (March 2001). "Universal Coverage in the United States: Lessons from Experience of the 20th Century." Journal of Urban Health: Bulletin of the New York Academy of Medicine 78, p. 46-58.

(3)"Health Insurance Coverage 2000," U.S. Census Bureau, September 28, 2001.

(4)Epstein, "Covering the Uninsured." p.524.

(5)Carey, Mary Agnes. (March 23, 2002). "Analysts See a Seismic Shift in Health Policy Debate." CQ Weekly.

(6)Henderson, James W. (2002). Health Economics and Policy, 2nd ed. U.S.A.: South Western. p. 109.

(7)Feldstein, Paul J. (2003). Health Policy Issues: An Economic Perspective, 3rd ed. Chicago: Health Administration Press. p. 383.

(8)Ibid. p. 384.

(9)Ibid. p. 384.

(10)Ibid. p. 390.

(11)Epstein, Keith. "Covering the Uninsured." p. 526

(12)Henderson, James W. Health Economics and Policy, 2nd ed. p. 511.

(13)"Infant Mortality Rates According to Race" Centers for Disease Control and Prevention, National Center for Health Care Statistics, 2001.

(14)Feldstein, Paul J. Health Policy Issues: An Economic Perspective, 3rd ed. p. 412.

(15)Donnelly, Tom in Keith Epstein "Covering the Uninsured." p. 536.

This was an entry for The 2004 Moffatt Prize in Economic Writing. See the contest rules for more information.

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Universal Coverage: A Bridge Too Far?