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Email Event
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America spends more than any other developed nation on health care--$2.1 trillion in 2007 alone--yet 46 million Americans are still uninsured, and those who are insured often receive costly but inappropriate care. While there is little doubt that the health system needs reform, there is substantial disagreement about the role
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of government versus that of the market. Congress must also determine whether comprehensive health system reform can be undertaken in light of the growing financial crisis facing the nation and the political failure of the 1992-93 Clinton health plan.
Oxford- and Harvard-educated political philosopher and medical doctor Ezekiel Emanuel argues in Healthcare, Guaranteed: A Simple, Secure Solution for America (PublicAffairs, 2008) that only comprehensive reform will save our inefficient and fiscally unsustainable health care system. Emanuel will present the case for a plan that ensures coverage for all Americans, replacing existing employment-based insurance with individual coverage held to national standards for coverage and affordability. AEI's Joseph Antos and Thomas P. Miller will discuss their views of the proposal and examine prospects for health reform in the new administration. AEI's Robert Helms will moderate.
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2:15 p.m.
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Registration
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2:30
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Presenter:
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Ezekiel Emanuel, M.D., National Institutes of Health
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Discussants:
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Joseph Antos, AEI
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Thomas P. Miller, AEI
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Moderator:
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Robert B. Helms, AEI
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4:30
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Adjournment
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A Democrat in Favor of Vouchers? Ezekiel Emanuel's Novel Health Reform Plan
WASHINGTON, DECEMBER 11, 2008--Health reform in the United States must guarantee health insurance coverage for all Americans and preserve choice while also integrating care and controlling costs, Ezekiel Emanuel argued at an AEI book forum on December 8. His plan includes components found in both Republican and Democratic proposals to reform health care.
Emanuel, a physician and the chairman of the Department of Bioethics at the Clinical Center of the National Institutes of Health, presented his recent book Healthcare Guaranteed (PublicAffairs 2008), in which he proposes a "Guaranteed Healthcare Access Plan." Its provisions include
- A certificate or voucher, to be distributed to all citizens, of sufficient value to purchase standardized benefit insurance from private companies providing qualified plans and funded through a 10 percent value-added tax
- Guaranteed issue of insurance to all Americans
- Allowances for risk-adjusted premiums
- Elimination of the tax exemption for employer-sponsored insurance
- Phasing out Medicare, Medicaid, and the State Children's Health Insurance Program
- Permission to use after-tax dollars to purchase coverage in excess of the standard benefit
- Establishment of a "National Health Board" to set the standard benefits package
- Establishment of an "Institute for Technology and Outcomes Assessment"
Emanuel would require health care plans to report data on outcomes (which would serve as an incentive to adopt health information technology broadly) and cover only services that pass a technology assessment (which is intended to eliminate wasteful spending on medical technology that does not offer significant improvements in outcomes over current practice standards). Consumers would purchase their own insurance through a national insurance exchange system rather than receiving it through their employers, a change that is aimed at reducing administrative costs as well as controlling the unsustainable cost growth of health services.
In addition to controlling costs, the plan could go a long way towards helping the economy, Emanuel said, because of how it would decouple employers from the provision of health insurance benefits. The average employee-sponsored family benefit currently costs $12,000 a year--roughly the cost of employing one minimum wage worker over the same time period. According to Emanuel, a portion of those health costs would be saved by employers who would no longer help pay health insurance premiums for their employees.
Thomas P. Miller and Joseph Antos, both health policy scholars at AEI and discussants at the forum, agreed with Emanuel's ideas of eliminating the tax exemption for employer-sponsored insurance and of risk-adjusted insurance vouchers. However, both expressed reservations about standardizing benefits packages, because such standardization would inhibit experimentation by insurance providers in an effort to strike a balance between meeting health care needs and offering excessive coverage. Each also expressed strong reservations about a National Health Board making blanket coverage and reimbursement decisions.
--WALTON DUMAS
Miller reviewed Healthcare, Guaranteed in Health Affairs. For more information about AEI's Health Policy Studies program, visit www.aei.org/health/.
For media inquiries, contact Veronique Rodman at 202.862.4870 or vrodman@aei.org.
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