FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 352:1255-1260 March 24, 2005 Number 12 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

	Full Text PDF PDA Full Text Purchase this article Editorial by Kronick, R. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

Dissatisfaction with the financing of U.S. health care is widespread. The system is inefficient, inequitable, and increasingly perceived to be unaffordable.^1,2,3,4 Because only incremental reform is deemed politically feasible, inordinate attention is devoted to treating the institutional symptoms rather than diagnosing systemic problems that require major surgery. As an alternative, we propose a voucher system for universal health care, an efficient, fair, and relatively simple approach that might elicit broad support. We recognize that change is not imminent, but such a proposal can stimulate discussion and provide a readily available model when the political climate becomes hospitable for endorsing meaningful . . . [Full Text of this Article]

Flaws in the Current Health Care Financing System

Features of the Voucher System

Universality

Free Choice of Health Plan

Freedom to Purchase Additional Services

Funding by an Earmarked Value-Added Tax

Reliance on a Private Delivery System

End of Employer-Based Insurance

Elimination of Medicaid and Other Means-Tested Programs

Phasing Out of Medicare

Administration

Assessment of Technology and Outcomes

Universal Benefits Package

Economic Feasibility

Political Feasibility

Issues Requiring Additional Study

Source Information

From the Posterity Project, Chicago (E.J.E.); and the Department of Economics, Stanford University, Stanford, Calif. (V.R.F.).

Related Letters:

A Proposal for Universal Coverage
Relman A. S., Hinkel J. M., Emanuel E. J., Fuchs V. R.
Extract | Full Text | PDF  
N Engl J Med 2005; 353:96-97, Jul 7, 2005. Correspondence

This article has been cited by other articles:

• Wen, C. P., Tsai, S. P., Chung, W.-S. I. (2008). A 10-Year Experience with Universal Health Insurance in Taiwan: Measuring Changes in Health and Health Disparity. ANN INTERN MED 148: 258-267 [Abstract] [Full Text]  
• Sessions, S. Y., Lee, P. R. (2008). A Road Map for Universal Coverage: Finding a Pass through the Financial Mountains. Journal of Health Politics, Policy and Law 33: 155-197 [Abstract]  
• Gibbons, R. J. (2007). Leading the Elephant Out of the Corner: The Future of Health Care: Presidential Address at the American Heart Association 2006 Scientific Sessions. Circulation 115: 2221-2230 [Full Text]  
• Krohmal, B. J., Emanuel, E. J. (2007). Access and Ability to Pay: The Ethics of a Tiered Health Care System. Arch Intern Med 167: 433-437 [Full Text]  
• Enthoven, A. C., Fuchs, V. R. (2006). Employment-Based Health Insurance: Past, Present, And Future. Health Aff (Millwood) 25: 1538-1547 [Abstract] [Full Text]  
• Olcott, C. IV (2006). The Pacific Coast Surgical Association in the New Millennium. Arch Surg 141: 729-733 [Full Text]  
• Fuchs, V. R., Emanuel, E. J. (2005). Health Care Reform: Why? What? When?. Health Aff (Millwood) 24: 1399-1414 [Abstract] [Full Text]  
• Relman, A. S., Hinkel, J. M., Emanuel, E. J., Fuchs, V. R. (2005). A Proposal for Universal Coverage. NEJM 353: 96-97 [Full Text]  
• Fuchs, V. R. (2005). Health Care Expenditures Reexamined. ANN INTERN MED 143: 76-78 [Full Text]  
• Kronick, R. (2005). Financing Health Care -- Finding the Money Is Hard and Spending It Well Is Even Harder. NEJM 352: 1252-1254 [Full Text]