Rockefeller J D
US Senate, Washington, DC 20510.
JAMA. 1991 May 15;265(19):2507-10. doi: 10.1001/jama.265.19.2507.
After a year of deliberation and investigation, the Pepper Commission recommended action to ensure that all Americans would have health insurance protection in an efficient, effective health care system. Because it believes that action is urgent, the commission would build universal coverage by securing, improving, and extending the combination of job-based and public coverage we now have. Reform would entail the following elements: a combination of incentives and requirements that would guarantee all workers (with their nonworking dependents) insurance coverage through their jobs; replacement of Medicaid with a new federal program that would cover all those not covered through the workplace and workers whose employers find public coverage more affordable; guaranteed affordable coverage for employers--through reform of private insurance, tax credits for small employers, and the opportunity to purchase public coverage; a minimum benefit standard for private and public plans that would cover preventive and primary services as well as catastrophic care and would include cost sharing, subject to ability to pay; and a combination of public and private sector initiatives to promote quality and contain costs.
经过一年的审议和调查,佩珀委员会建议采取行动,以确保所有美国人在高效、有效的医疗保健系统中都能获得医疗保险保障。由于委员会认为行动刻不容缓,它将通过巩固、改进和扩大我们现有的基于就业和公共医保的组合来建立全民医保覆盖。改革将包括以下要素:一系列激励措施和要求,以确保所有工人(及其无工作的受抚养人)通过工作获得保险覆盖;用一个新的联邦项目取代医疗补助计划,该项目将覆盖所有未通过工作场所获得保险的人和其雇主认为公共医保更实惠的工人;通过私人保险改革、对小企业的税收抵免以及购买公共医保的机会,为雇主提供有保障的可负担医保;为私人和公共医保计划设定最低福利标准,涵盖预防和基本服务以及灾难性医疗,并根据支付能力实行费用分摊;以及公共和私营部门共同采取举措来提高质量和控制成本。