Pauly M V
Health Care Systems Department, University of Pennsylvania, Philadelphia.
Health Aff (Millwood). 1994 Spring;13(1):147-60. doi: 10.1377/hlthaff.13.1.147.
This paper points out four difficult choices embedded in the Clinton plan. First, universal coverage is achieved, but with regressive head-tax financing on many workers-since the cost of the employer mandate ultimately will fall on workers' wages. Perhaps such an approach can be made politically acceptable. Second, cost containment is entrusted to global spending limits, which will limit the rate of improvement in quality. Third, the offering of choice among a variety of health plans of different costs and quality, although desirable in itself, may lead to inequity. Finally, the plan's financing will make it difficult for voters to tell what trade-offs they are making, because employer mandates and budget cuts disguise choices.
本文指出了克林顿计划中蕴含的四个艰难抉择。其一，实现了全民医保，但许多工人需缴纳累退人头税来筹资，因为雇主强制参保的成本最终会落到工人工资上。或许这样的做法在政治上能被接受。其二，成本控制依赖于总体支出限制，这会限制医疗质量的提升速度。其三，提供多种不同成本和质量的医保计划供人选择，尽管这本身是件好事，但可能导致不公平。最后，该计划的筹资方式会让选民难以知晓他们正在做出怎样的权衡取舍，因为雇主强制参保和预算削减掩盖了这些选择。
