Voluntary Health Reform

There’s a continuum of alternative market-oriented approaches to expanding health insurance coverage while also introducing system reforms designed to improve value for money in health care. These approaches are listed in approximate order of their impact on the number of uninsured and degree of government involvement in perfecting health insurance or health services markets. While all approaches are intended to reduce the costs of health insurance, thereby expanding coverage, the latter six includes features designed to achieve universal health coverage.

  1. Individual Pay or Play proposed by John Goodman; this is a minimalist version of a broader reform envisaged by Goodman built on converting the tax exclusion into universal tax credits.
  2. Health Status Insurance proposed by John Cochrane.
  3. Universal Health Savings Accounts proposed by John Goodman. See also Health Care for All without the Affordable Care Act by John Goodman and Peter Ferrara  and its companion slideshow 10 Steps to Universal Coverage without a Mandate which incorporates both individual pay or play and health status insurance concepts.
  4. Standard Tax Deductions proposed by the Bush administration in 2007.
  5. Fixed Tax Credits proposed in the Every American Insured Health Act introduced by Senator Richard Burr in July 2007.
  6. Voluntary Income-Related Tax Credits proposed by Mark Pauly and John Hoff in Responsible Tax Credits and endorsed by the American Medical Association.
  7. Health Insurance Exchanges proposed by Sara Singer, Alan Garber and Alain Enthoven (covers only non-elderly).
  8. Universal Health Insurance Exchanges proposed by Douglas Holtz-Eakin and Avik Roy (covers Medicare and Medicaid in addition to privately insured)

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