U.S. Universal Health Coverage at a Crossroad

Abstract

Scheduled for 2014, implementation of universal coverage in the U.S. is not proceeding smoothly. Embroiled in bitter partisan conflict and absent decisive popular support, this costly new entitlement program, The Affordable Care Act commonly referred to as ObamaCare, is vulnerable to a major overhaul or possible rejection. National interest considerations urge that reformulation center on better matching the law’s aspirations with new realities rather than abstract ideals. Constraints on government spending and the risks public indebtedness pose for the national economy compel a pragmatic reassessment of entitlement policy in the light of what is affordable. ObamaCare compounds the government’s unsustainable debt and deficit problem, promising benefits that are overly generous and lack effective cost controls. Fiscal imperatives compel that scarce government resources be targeted on the truly needy and that individuals capable of doing so assume a greater responsibility for their health care. They also necessitate a more sophisticated public-private partnership than provided in the new health law in order to capture the benefits of market competition that facilitate innovation, circumvent political stalemate, confine the inflationary effects of services perceived to be free goods, and provide incentives that reward individuals for becoming more cost-conscious users of health services. Finally, the harnessing of self-interest is presented as a superior alternative to centralized command and control methods for influencing health behavior and keeping health spending under control. In the interest of economy and efficiency, government involvement, following the subsidization of low income persons on a sliding scale basis, should concentrate on standard setting, monitoring and evaluating productivity and quality improvement practices. Ultimately, living standards contribute more to health status than do health services, and this requires investment directed at economic growth.