Universal Health Care Coverage -- Pitfalls and Promise of an Employment-Based Approach
Journal of Medicine and Philosophy. 1992 Feb; 17(1): 21-32.
America's patchwork quilt of health care coverage is coming apart at the seams. The system, such as it is, is built upon an inherently problematic base: employment. By definition, an employment-based approach, by itself, will not assure universal coverage of the entire population. If an employment-based approach is to be the centerpiece of a system that provides universal coverage, special attention must be paid to all the categories of individuals who are not employees -- children, unemployed spouses or singles, the unemployable ill and disabled, persons between jobs, students, retirees, the elderly. Moreover, in a purely voluntary employment-based arrangement, some employers will not provide insurance at all, and others will provide inadequate coverage, necessitating other special provisions for coverage....[T]he rapidly-increasing transaction costs of sustaining this grossly inadequate pluralistic system eat up sufficient funds to provide basic benefits to the entire population. The time for systematic reforms has come and gone; what is now needed is action to prevent disaster, followed by a complete rebuilding of this country's health coverage system....Passage of inadequate reforms, then, could well set the stage for nationalized health care in the not too distant future.
Aged; Children; Discrimination; Economics; Employment; Evaluation; Family Members; Federal Government; Financial Support; Government; Health; Health Care; Health Care Delivery; Health Insurance; Indigents; Industry; Insurance; National Health Insurance; State Government; Students; Spouses; Voluntary Programs;
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