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Next Social Contract: Policy P

A Sustainable Health System for All Americans

Executive Summary

America’s health care system fails to meet the standards set by its peers around the world. It delivers substandard patient care far too often, leaves tens of millions uninsured, and its rising cost growth threatens the foundations of our economy and society. Unless we move toward comprehensive, system-wide reform, we will continue to waste billions of dollars and thousands of lives every year in a health care system that is riddled with ineffi ciencies. A health care system for the Next Social Contract should correct these deficiencies by expanding coverage, creating better incentives for quality and efficiency, and linking health insurance to individuals, rather than to their place of employment. It should be guided by the principles of personal responsibility for one’s own health and shared responsibility to ensure the health and welfare of all our citizens, including our most vulnerable ones.

This paper outlines what a health system under the Next Social Contract ought to look like. It would shift the responsibility for providing health insurance from the employer to the individual, freeing American companies to concentrate on growth and competitiveness without having to worry about rising health care costs. It would make health insurance mandatory for all U.S. citizens, but it would also offer generous subsidies and large risk pools to help defray the cost of premiums. It would be guided by a refocused approach to health care delivery that emphasizes prevention, early diagnosis, and evidence-based treatments rather than expensive and often known-to-be ineffective diagnostic and treatment techniques. And it would encourage the widespread adoption of information technology to reduce administrative costs and help all clinicians and patients share best-practice information in real time.

The stakes are high. A failure to act to stem rising health care costs will jeopardize our public’s health and undercut our international competitiveness. And the failure to make affordable health care available to the 45 million Americans who are currently uninsured is morally indefensible. But the current crisis of our health care system is also an opportunity to rethink its basic tenets and improve its overall performance. If we use this opportunity wisely, we will fashion a health care system suited to the needs of citizens in a 21st century society.

For the complete policy proposal, please see the attached PDF below.

About the Next Social Contract Initiative

The Next Social Contract Initiative aims to reinvent American social policy for the 21st century. Through a program of research and public education, the initiative will explore the origins of our modern social contract, articulate the guiding principles for constructing a new contract, and advance a set of promising policy reforms. To learn more about this initiative, please click here.

Universal insurance coverage is at least as much about wise stewardship of scarce social resources as it is about charity for the poor.