Harold S. Luft

 

On his book Total Cure: The Antidote to the Health Care Crisis

Cover Interview of January 06, 2009

Lastly

Some will ask, “if this is all so simple, why hasn’t it already been done?”  The key is that the proposal doesn’t try to solve all our problems with the limited set of tools we have been using in the past.  It adds new tools and seizes new opportunities that had not been available heretofore.  Insurance for hospitalization and chronic illness is critically important for everyone, hence SecureChoice uses a universal pool for those aspects of care.  Insurance is not really needed, nor well-designed, for other types of care.  People may want help in smoothing out the costs of such care, but that is more like a credit card than insurance.  Income-based subsidies address the affordability problems for those people who need help in covering those costs.

Integrated health plans were created to coordinate and manage care, but they are a solution for only a small fraction of the population and practitioners.  New health information systems and re-aligned incentives can allow many of those benefits without forcing independent physicians into large groups or restricting the choices of patients.  Employment-based insurance developed by historical accident in the years following World War II; subsequent policy changes inadvertently fragmented the insurance market and sapped its ability to foster innovation in practice.  The shift to defined contributions by employers, however, creates the opportunity to build on long-standing compensation structures in a new world in which families have multiple workers, sometimes with several jobs each.  The political window of opportunity is opening for changes that are less ideological and combine the collective action potential of government with the flexibility and innovation of well-designed markets.  Now is the time to give fundamental reform serious consideration.


© 2009 Harold Luft