Guaranteed HealthCare Access at a Glance

By most standards of measure, the American health system is inefficient, inequitable, and increasingly perceived to be unaffordable. Because only incremental reform is deemed politically feasible, inordinate attention is devoted to treating the institutional symptoms rather than diagnosing systemic problems that require major surgery. Only a comprehensive approach to health system reform will assure that all Americans will have access to health insurance, that the quality of the care they receive will be commensurate with its cost and that the increasing cost of health care will at last come under control.

The Guaranteed Healthcare Access plan is an approach to comprehensive health system reform conceived by Ezekiel Emanuel, Chairman, Department of Medical Bioethics, National Institute of Health, and Victor Fuchs, Professor of Economics (emeritus), Stanford University, and originally summarized in an article in the New England Journal of Medicine published on March 24, 2005 and elaborated upon in a paper presented to The Brookings Institute on July 17, 2007. The essence of their approach can be summed up in its ten fundamental features:

• Guaranteed health care for all Americans: Every American would receive a voucher from the Federal government that would guarantee and pay for defined health services from a qualified health plan or insurance company.
• Comprehensive benefits: The voucher would cover a set of comprehensive benefits modeled on the generous benefits that federal employees and members of Congress receive today
• Free choice of health plan and providers: Individuals and families would choose which basic insurance program or health plan they wanted among qualified alternatives and would be free to choose their providers.
• Freedom to purchase additional services: People who wanted to purchase additional services or amenities could do so with their own after tax dollars.
• Funding by an earmarked value-added tax: Funding for the vouchers would come from an earmarked value-added tax, or similarly discrete, dedicated tax.
• End of employer-based insurance: With basic care for all Americans provided, and the tax benefits for health insurance premiums eliminated, employer-based insurance would likely fade away.
• Phasing out of Medicare, and Medicaid and other means-tested programs: There would be no new enrollees in Medicare, Medicaid and other government healthcare programs. People currently enrolled in these programs would have the option of continuing or joining the voucher program.
• Independent oversight: Management and oversight of the system would be the responsibility of National and Regional Health Boards, which would be supported by the VAT, not annual Congressional appropriations, to maintain their political independence.
• Cost and quality control: An independent Institute for Technology and Outcomes Assessment would be responsible for judging the value of new drugs, medical devices, tests and other interventions and to assess patient outcomes.
• Patient safety and dispute resolution: Each regional Health Board would create a regional center for patient safety and dispute resolution generating more equitable results and eliminating costly and contentious malpractice suits.