Tradeoffs One Economist’s Plan to Blow Up America’s Health Insurance System
Nov 27, 2025
In this engaging conversation, Amy Finkelstein, a Professor of Economics at MIT and MacArthur Fellow, shares her radical vision for America's health insurance. With over 20 years of research, she argues for a complete system overhaul, proposing universal free basic coverage. Finkelstein highlights the instability of current insurance, revealing that 25% of Americans experience coverage gaps. She discusses the harmful effects of co-pays on access to essential medications and suggests automatic enrollment to simplify access and reduce inequalities in health care.
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Insurance Fails Its Core Purpose
- Health insurance should provide stability, but in the U.S. it's itself highly unstable with many losing coverage when they need it most.
- Amy Finkelstein argues this instability shows the system fails its basic purpose and needs rebuilding.
One-Line Blueprint For Reform
- The proposed blueprint: free, automatic basic coverage for all, plus optional supplemental purchases for extras.
- Amy Finkelstein presents this as a simple high-level solution to systemic insurance failures.
Eligibility Without Enrollment
- About six in ten uninsured people are already eligible for free or heavily subsidized insurance but not enrolled.
- Finkelstein uses this to argue automatic universal enrollment would close large gaps caused by complexity.
