Davis K
Department of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD.
JAMA. 1991 May 15;265(19):2525-8.
This article presents a proposal for expanding Medicare and employer-based health insurance plans to achieve universal health insurance. Under this proposed health care financing system, employees would provide basic health insurance coverage to workers and dependents, or pay a payroll tax contribution toward the cost of their coverage under Medicare. States would have the option of buying all Medicaid beneficiaries and other poor individuals into Medicare by paying the Medicare premiums and cost sharing. Other uninsured individuals would be automatically covered by Medicare. Employer plans would incorporate Medicare's provider payment methods. This proposal would result in incremental federal governmental outlays on the order of $25 billion annually. These new federal budgetary costs would be met through a combination of premiums, employer payroll tax, income tax, and general tax revenues. The principal advantage of this plan is that it draws on the strengths of the current system while simplifying the benefit and provider payment structure and instituting innovations to promote efficiency.
本文提出了一项扩大医疗保险和基于雇主的健康保险计划以实现全民健康保险的提议。在这个提议的医疗保健融资体系下，雇主将为工人及其家属提供基本医疗保险，或者为他们在医疗保险下的保险费用缴纳工资税。各州可以选择通过支付医疗保险费和费用分摊，将所有医疗补助受益人及其他贫困人口纳入医疗保险。其他未参保个人将自动纳入医疗保险。雇主计划将采用医疗保险的医疗服务提供者支付方式。这项提议将导致联邦政府每年增加约250亿美元的支出。这些新的联邦预算成本将通过保费、雇主工资税、所得税和一般税收收入的组合来支付。该计划的主要优点是，它利用了现有体系的优势，同时简化了福利和医疗服务提供者支付结构，并进行创新以提高效率。
