Public Policy

I'm taking a class entitled Bioethics and the Law. In conducting research for my major paper, I ran across an interesting article in the California Law Review by Einer Elhague, entitled Allocating Health care Morally. Here is Elhague's concrete proposal (which he then justifies in over 90 pages of in-depth argument) directly quoted from pages 1453-1454

(1) A politically set annual health care budget with an associated tax not linked to employment

(2) Free access for all individuals to a care-allocating plan

(3) Individual choice about which plan they wish to join for some significant period (I suggest three years)

(4) Competition among care-allocating plans that each receive a share of the government budget based on the number of individuals they enroll, adjusted for each person's health risk, and that cannot retain profits from their budget (other than a possible bonus linked to total number of enrollees) but must instead spend it on those enrollees. Plans must accept all who wish to enroll

(5) Management of those care-allocating plans by professional who have the range of diagnostic expertise to evaluate the health care needs of plan enrollees, who have salaries unaffected by spending decisions (other than a possible bonus per enrollee), and who have a duty to decide how to allocate each plan's budget to purchase those health services that maximize health benefits fro the unit's enrollees. Their sole incentive should thus be to do a good enough job at rationing to keep and attract enrollees

(6) Maintenance of the vast majority of health care providers as private suppliers of procedures, tests, and technologies that compete with each other to sell to the care-allocating plans. This should create incentives for cost-effective innovation because suppliers will now face purchaser who have both the knowledge and incentives to trade off the costs and benefits of care.

(7) A politically appointed agency, the members of which are insulated from removal, that has only two tasks: setting risk adjustments and licensing care-allocating plans by verifying their diagnostic expertise and fiscal soundness. In particular, this agency would not dictate a uniform schedule of covered services because that would be up to each care-allocating plan.

(8) The individual right to purchase additional care outside these plans on the open market

What do you think?