We’ve Got You Covered: Rebooting American Health Care

The only reason the U.S. healthcare system is not completely broken is because there’s no solid thing to break, argue economists Einav and Finkelstein (coauthors, Risky Business) in this impassioned call for ground-up reform. According to the authors, critics of the current system of medical coverage tend to overfocus on the 30 million uninsured Americans, when in fact 90% of the total population is underinsured, at risk of losing coverage, or saddled with significant debt. Einav and Finkelstein contend that the government ought to take inspiration from the success of systems like those in Singapore and the U.K. by drawing a distinction between “health” and “care” and developing an approach more comparable to air travel: those who can afford to fly first class may be more comfortable, but everyone on board gets from point A to point B. Countering arguments that the integrity of such a system, even when guaranteed by law, would be threatened by variations among factors like hospital wait times, the authors draw on philosopher John Rawls’s equality principle, which they claim suggests that guaranteed adequacy is better than failed equality. Thanks to the sensible pragmatism of the authors’ approach, healthcare reform activists will find this a useful tool. (July)