Liran Einav and Amy Finkelstein, "We've Got You Covered: Rebooting American Health Care" (Penguin, 2023)
Aug 21, 2023
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Liran Einav, Stanford health economist, and Amy Finkelstein, MIT economist and MacArthur Genius, discuss the need to rebuild the American health care system. They argue for automatic, basic, and free universal coverage for everyone, along with the option to buy additional, supplemental coverage. They explore topics such as wait times, basic coverage, financial security, minimum insurance, catastrophic policies, inequality in healthcare, and the future of employer-paid health care.
Universal automatic basic coverage is crucial in reinventing the future of healthcare and addressing the inefficiency and inequity of the current system.
Universal coverage should provide free and comprehensive essential medical care, reducing financial barriers for patients and accommodating individual preferences through supplemental coverage.
The commitment to universal coverage is a significant aspect of US healthcare policy, and learning from international approaches can help in designing a system that suits the particular context of the United States.
Deep dives
The Need for Universal Automatic Basic Coverage
The podcast episode discusses the importance of universal automatic basic coverage in reinventing the future of healthcare. It emphasizes the inefficiency and inequity of the current healthcare system and the need for a paradigm shift. The hosts argue that universal coverage should be automatic, providing essential medical care without financial burden. The goal is to ensure that everyone has access to necessary care, addressing health disparities and improving population health. The episode highlights the benefits of universal coverage and cautions against the misconception that it equates to equality in healthcare.
Elements of Universal Automatic Basic Coverage
The podcast explores the key elements of universal automatic basic coverage. It discusses the importance of free and comprehensive coverage for essential medical care, including preventive and primary care as well as care for chronic diseases. The episode emphasizes that coverage should be basic and free, reducing financial barriers for patients. While the focus is on basic coverage, the hosts acknowledge the need for supplemental coverage to accommodate individual preferences. Additionally, the discussion considers the challenges of balancing wait times and ensuring the adequacy of the basic system.
Understanding the Social Contract and Commitment
The podcast delves into the social contract and commitment to provide essential medical care. It explores how various public programs and funding systems have inadvertently created a patchwork of coverage, resulting in inefficiency and confusion. The episode emphasizes the need to formalize and fund the commitment to provide access to care regardless of resources. It discusses the importance of understanding the objective of US healthcare policy and identifies the commitment to universal coverage as a significant aspect. The hosts address concerns about health disparities, explaining that addressing these disparities requires targeted policies beyond medical care.
Comparing International Approaches to Healthcare
The podcast highlights various international approaches to healthcare and their relevance to the universal coverage model discussed. It points out that most high-income countries have embraced the idea of universal automatic coverage for essential medical care. The episode mentions countries like the UK, Canada, Switzerland, the Netherlands, Australia, and Singapore, each with their unique systems. While no country perfectly aligns with the ideal model presented, the podcast emphasizes the importance of looking at different approaches and learning from their successes and challenges. It underscores the need to adapt and design a system that suits the particular context of the United States.
Addressing Concerns and Misconceptions
The podcast addresses common concerns and misconceptions surrounding the proposed universal coverage model. It challenges the notion that providing basic coverage without patient payments will lead to overuse of healthcare services. The hosts cite evidence from countries where such models are implemented and highlight the importance of addressing non-medical factors in reducing health disparities. The episode also discusses the role of employers in providing coverage and clarifies that employer-based coverage can coexist with the universal system. Finally, it emphasizes that the universal coverage proposal transcends political ideologies, appealing to a broad spectrum of policymakers and thought leaders.
Few of us need convincing that the American health insurance system needs reform. But many of the existing proposals focus on expanding one relatively successful piece of the system or building in piecemeal additions. These proposals miss the point.
As the Stanford health economist Liran Einav and the MIT economist and MacArthur Genius Amy Finkelstein argue, our health care system was never deliberately designed, but rather pieced together to deal with issues as they became politically relevant. The result is a sprawling yet arbitrary and inadequate mess. It has left 30 million Americans without formal insurance. Many of the rest live in constant danger of losing their coverage if they lose their job, give birth, get older, get healthier, get richer, or move.
It's time to tear it all down and rebuild, sensibly and deliberately. Marshaling original research, striking insights from American history, and comparative analysis of what works and what doesn’t from systems around the world, Einav and Finkelstein argue for automatic, basic, and free universal coverage for everyone, along with the option to buy additional, supplemental coverage. Their wholly original argument and comprehensive blueprint for an American universal health insurance system will surprise and provoke.
John Emrich has worked for decades years in corporate finance, business valuation and fund management. He has a podcast about the investment space called Kick the Dogma.
