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A Potential Hybrid Solution

Harold S. Luft, PhD

JAMA. 2007;297:1115-1118.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The United States spends a greater share of its gross domestic product on health care than other nations, yet more than 15.9% of its population lacks health insurance coverage.¹ The US health measures are no better (and are often worse) than those of other nations.² This combined inequity and inefficiency creates a moral imperative and opportunity for change. Some argue for a single-payer system, others for more reliance on the market and insurance subsidies. Apart from causing political gridlock, neither strategy would effectively both guarantee coverage and constrain costs. A hybrid approach combining universal risk pools, mandated coverage with income-based subsidies, and a restructured payment mechanism has the potential to improve both equity and efficiency.

Medicare—the Prototypical Single-Payer Model

Medicare, which provides near-universal coverage to US residents 65 years and older, is the prototypical single-payer model and routinely exhibits the problems of the model. Although permitted to arbitrarily set fees, . . . [Full Text of this Article]

Author Affiliation: Institute for Health Policy Studies, University of California, San Francisco.

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