Single Payers and Multiple Lists: Must Everyone Get the Same Coverage in a Universal Health Plan?
Veatch, Robert M.
Kennedy Institute of Ethics Journal. 1997 Jun; 7(2): 153-169.
In spite of recent political setbacks for the movement toward universal health insurance, considerable support remains for the idea. Among those supporting such plans, most assume that a universal insurance system, especially if it is a single-payer system, would offer a single list of basic covered services. This paper challenges that assumption and argues for the availability of multiple lists of services in a universal insurance system. The claim is made that multiple lists will be both more efficient and more fair. Any single list will fund some services that are quite attractive to some people, but only marginally attractive to others. Thus any single-list plan will fund some services that produce only marginal benefit for the resources used. Moreover, since some people will hold values quite compatible with the single list and others will hold values leading to preferences for unfunded services, some people will get much more benefit from any single list than other people will. Fairness and efficiency require providing an entitlement to universal access to health insurance that could be purchased by typical consumers for a fixed price of perhaps $3500. By permitting everyone to pick their preferred list of services available at that price, each person will efficiently use his or her entitlement while getting more equal opportunity for benefits.
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Just Caring: Gridlock and the Challenge of Health Reform Review of MEDICAL GRIDLOCK and HEALTH REFORM, by Eli Ginzberg; HEALTH CARE REFORM: A HUMAN RIGHTS APPROACH, Edited by Audrey R. Chapman; and SELF-INTEREST and UNIVERSAL HEALTH CARE: WHY WELL- INSURED AMERICANS SHOULD SUPPORT COVERAGE for EVERYONE, by Larry R. Churchill Fleck, Leonard M. (1995-09)