Meeting the Dilemma of Health Care Access: Extend Insurance Coverage while Controlling Costs

Henry J. Aaron and
Henry J. Aaron The Bruce and Virginia MacLaury Chair, Senior Fellow Emeritus - Economic Studies

Joseph P. Newhouse

February 28, 2007

The American public has a right to expect all Presidential candidates to address certain specific health system shortcomings, including the need to increase access to health care, reform Medicare and other financing, improve quality, and tackle medical malpractice reform. These issues have figured prominently in recent political debates, and they can be solved by several policy options.

The next President will have to choose some variant of the following specific options:

  • increasing consumers’ share of health costs through high-deductible insurance, as an alternative to expanding employment-based coverage
  • incremental change to strengthen and extend employment-based health coverage, through reinsurance or making federal insurance programs (Medicare, Medicaid, or the Federal Employees Health Benefits Program) more widely available
  • universal health insurance by means of “Medicare-for-all”
  • support for state-level reforms-which may be the most politically feasible of these alternatives

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