Health policy goals include access to quality care at an affordable cost and the advancement of medical research. While differences remain about the exact form of care that should be available to Americans, a general consensus has emerged about the nature of a public system’s role: ensuring that all citizens have access to basic care and services, facilitating research in medicine, and providing equitable assistance to pay for those needs.
Achieving those objectives will require substantial reform of healthcare. Among other things, it should move toward a seamless market, eliminating the fragmentation that presently exists across Medicare, Medicaid, private insurance markets, employers’ sponsored plans, and government-run programs. It should allow standard insurance to accommodate people with preexisting conditions, rather than taking the heavy-handed approach of requiring insurers to cover everyone regardless of their condition (which has wrecked health systems in numerous states). And it should provide physicians sufficient autonomy to focus on patients’ wishes and rewards those who innovate.
It should also eliminate the distortions that occur when people’s incomes and employment status influence their ability to buy health coverage. And it should re-establish horizontal equity in financial assistance, by allowing working families to receive subsidies to afford insurance regardless of their place or sector of employment, size of employer, or whether they work seasonally or part time. This will benefit the lower-paid, minorities, and households that move sporadically between jobs—precisely those groups who experience the highest rates of uninsurance today.