Characteristics Of An Ideal Health Care System

Policy Reports | Health

No. 242
Monday, April 30, 2001
by John C. Goodman


The author would like to acknowledge helpful comments from Ben Lytle, Gerald Musgrave, James Rodgers and Greg Scandlen.

  1. Robert J. Mills, Current Population Report, Health Insurance Coverage: 1999, P60-211, U. S. Census Bureau, September 2000.
  2. Jill M. Yegian et al., "The Nonpoor Uninsured in California, 1998," Health Affairs, July/August 2000.
  3. Melinda L. Schriver and Grace-Marie Arnett, "What States Can Teach Congress About Health Care Regulation, Heritage Foundation, Backgrounder No. 2107, July 23, 1998.
  4. John C. Goodman and Gerald L. Musgrave, "Freedom of Choice in Health Insurance," National Center for Policy Analysis, NCPA Policy Report No. 134, November 1988.
  5. Frank A. Sloan and Christopher J. Conover, "Effects of State Reforms on Health Insurance Coverage of Adults," Inquiry, Vol. 3 (1998), pp. 280-93.
  6. Gail A. Jensen and Michael A. Morrisey, "Mandated Benefit Laws and Employer-Sponsored Health Insurance," Health Insurance Association of America, January 1999.
  7. A group health plan can apply preexisting condition exclusions for no more than 12 months except in the case of late enrollees to whom exclusions can apply for 18 months.
  8. Health Care Financing and Organization: News and Progress, March 2000, pp. 5-6.
  9. American Health Line, March 31, 2000.
  10. Lewin Group estimates using the Health Benefits Simulation Model.
  11. There are many different ways to structure a subsidy. Although it is not the primary focus of this paper, an ideal subsidy would not distort decicions at the margin. That is, people should be able to choose on a level playing field between health care and nonhealth care and between health care today and health care tomorrow. See Mark V. Pauly and John C. Goodman, "Tax Credits for Health Insurance and Medical Savings Accounts," Health Affairs, Vol. 14, No. 1, pp. 126-39. Spring 1995.
  12. Low-income families who do not otherwise owe any federal income tax will not literally be paying their own way. But in foregoing, say, a $1,000 refundable tax credit they will be making a decision that allows the $1,000 to be deposited in a local safety net.
  13. To my knowledge, this idea as first proposed in John C. Goodman and Gerald L. Musgrave, Patient Power: Solving America's Health Care Crisis (Washington, D.C.: Cato Institute, 1992), pp. 641-45. For a similar approach, see Lynn Etheredge, "A Flexible Benefits Tax Credit for Health Insurance and More," Health Affairs Special Internet-only Publication,
  14. Some patients may be high cost. In a private insurance market, insurers will not agree to insure someone for $1,000 if his or her expected cost of care is, say, $5,000. But if the safety net agency expects a $5,000 savings as a result of the loss of a patient to a private insurer, the agency should be willing to pay up to $5,000 to subsidize the private insurance premium.
  15. We can readily grant that there is no social reason to care whether Bill Gates is insured. So there could be an income or wealth threshold, beyond which the subsidy/penalty system does not apply. However, as a practical matter there are so few individuals that would qualify for an exemption that uniform treatment for everyone is administratively attractive.
  16. C. Eugene Steuerle, "Child Credits: Opportunity at the Door," Urban Institute, 1997.
  17. The exceptions are mandated maternity coverage in most health plans, and federal mandates requiring a 48 hour hospital stay after a well-baby delivery if requested by a patient and physician and mandated mental health parity.
  18. M. Susan Marquis and Stephen H. Long, "Recent Trends in Self-Insured Employer Health Plans," Health Affairs, Vol. 18, No. 3, May/June 1999, pp. 161-66.

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