Stanford University, Stanford, California (L.E.).
Massachusetts Institute of Technology, Cambridge, Massachusetts (A.F.).
Ann Intern Med. 2024 Jun;177(6):812-816. doi: 10.7326/M24-0091. Epub 2024 May 14.
The current U.S. health insurance "system" was not deliberately planned and constructed but has emerged piecemeal over the past half-century through a series of incremental and haphazard reforms. That policy history also reveals a clear but unfulfilled societal commitment to providing access to essential health care regardless of resources. To fulfill this obligation, the solution proposed in this article has 2 key elements: 1) universal coverage that is automatic, free, and basic, and 2) the option to buy supplemental coverage in a well-designed market. Such a system could, if desired, be created without raising taxes and without disrupting or changing the delivery of medical care.
当前的美国健康保险“体系”并非刻意规划和构建，而是在过去半个世纪中通过一系列渐进式和随意的改革逐渐形成的。这段政策历史也清晰地揭示了一个未竟的社会承诺，即为所有人提供必要的医疗保健，而不论其资源如何。为了履行这一义务，本文提出的解决方案有 2 个关键要素：1）自动、免费且基本的全民覆盖；2）在精心设计的市场中购买补充保险的选择。如果需要，可以在不提高税收、不扰乱或改变医疗服务提供的情况下创建这样的系统。
