Uwe Reinhardt: Unifying themes for healthcare policies

Uwe Reinhardt at Economix sums up health care policy proposals over the last decades(hat tip save the rustbelt)

To describe the unifying theme running through these past variants, it is helpful to enumerate the major economic functions any health system must perform:

  1. Producing health-care goods and services.
  2. Financing health care, which involves extracting money from households (which ultimately pay for all of health care) and funneling it to the producers of health care, usually through the books of private or public health insurers.
  3. Risk pooling by private or public insurers to protect individuals from the financial inroads of high medical bills through insurance policies.
  4. In most modern societies, assuring that every member of society has timely access to a defined set of health-care benefits.
  5. Purchasing medical treatments from the producers of health care, which includes determining the prices to be paid, claims processing for insured patients and controlling overall spending and the quality of that care with various forms of controls lumped together under the generic label “managed care.”
  6. Regulating the behavior of the various participants in the system to preserve the integrity of health care markets and the safety of health-care products and services.

Most of the debate over health policy in this country has been over two questions.

First, to what extent should healthier or wealthier members of society be asked to subsidize the health care received by their poorer or sicker fellow Americans? Second, influenced by the answer to the first question, who should perform the functions listed above: government, private nonprofit entities or for-profit entities?