Bodenheimer T
Int J Health Serv. 1992;22(2):197-215. doi: 10.2190/P27E-789J-V9XM-2UPW.
A number of health insurance reform proposals have surfaced at the state governmental level in the United States. These include Medicaid expansion for the below-poverty or near-poverty uninsured, state subsidy to individuals and/or businesses for the purchases of health insurance, risk pools for the medically uninsurable, insurance industry-initiated reforms within the small group market, the promotion of "stripped down" insurance plans that reduce premium cost, and state mandating of employer-sponsored health insurance for the employed uninsured. All of these insurance reform proposals have serious limitations: (1) they fail to address the inequities of the underwriting principle by which older and sicker people pay more for health insurance than the young and healthy population; (2) they extend the illogical linkage of employment and health insurance; and (3) they do not slow the rate of health cost inflation nor do they contain a mechanism to finance broader health coverage through savings within the health sector. An alternative to insurance reform is the establishment of a social insurance program that brings the entire population into a single risk pool.
在美国，州政府层面已经出现了一些医疗保险改革提案。这些提案包括为贫困线以下或接近贫困线的未参保者扩大医疗补助计划、向个人和/或企业提供购买医疗保险的州补贴、为无法参保的人群设立风险池、保险行业在小团体市场发起的改革、推广降低保费成本的“简化版”保险计划，以及要求州政府强制为未参保的就业人员提供雇主赞助的医疗保险。所有这些保险改革提案都有严重的局限性：（1）它们未能解决承保原则中的不公平问题，即年长者和患病者比年轻健康者支付更高的医疗保险费用；（2）它们延续了就业与医疗保险之间不合逻辑的联系；（3）它们既没有减缓医疗成本通胀率，也没有包含通过医疗部门内部的储蓄为更广泛的医疗保险提供资金的机制。保险改革的一个替代方案是建立一个社会保险计划，将全体人口纳入单一风险池。
