title: Private insurance reform in the 1990s: can it solve the health care crisis?
abstract: A number of health insurance reform proposals have surfaced at the state governmental level in the United States. These include Medicaid expansion for the below-poverty or near-poverty uninsured, state subsidy to individuals and/or businesses for the purchases of health insurance, risk pools for the medically uninsurable, insurance industry-initiated reforms within the small group market, the promotion of "stripped down" insurance plans that reduce premium cost, and state mandating of employer-sponsored health insurance for the employed uninsured. All of these insurance reform proposals have serious limitations: (1) they fail to address the inequities of the underwriting principle by which older and sicker people pay more for health insurance than the young and healthy population; (2) they extend the illogical linkage of employment and health insurance; and (3) they do not slow the rate of health cost inflation nor do they contain a mechanism to finance broader health coverage through savings within the health sector. An alternative to insurance reform is the establishment of a social insurance program that brings the entire population into a single risk pool.
authors.forename: T
authors.initials: T
authors.lastname: Bodenheimer
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D006264:Health Benefit Plans, Employee / Q000191:economics / Q000331:legislation & jurisprudence; D006291:Health Policy / Q000191:economics / Q000331:legislation & jurisprudence*; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D015271:Insurance Pools; D007348:Insurance, Health / Q000191:economics / Q000331:legislation & jurisprudence*; D008297:Male; D017057:Medically Uninsured / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D009310:National Health Insurance, United States / Q000191:economics / Q000331:legislation & jurisprudence; D014481:United States