Organizing the Health Insurance Market
提出一种新的全民健康保险组织方式，由政府划分人群、建立类似美联储的联邦健康保险系统，通过招标和定价实现社会最优保险，切断保险与就业的联系。
This paper presents a new approach to organizing universal health insurance. First the government divides the entire population into many large groups. Then, the government creates a Federal Health Insurance System (HealthFed), modeled on the Federal Reserve System, to fill the role now played by the benefits office of a large firm. The HealthFed would create a short menu of alternatives, solicit bids for insuring the entire group, and price alternatives. There would be redistribution between groups and pricing of alterna- tives to reflect optimal social insurance principles. There would be no connection between health insurance and employment. IT MAY SEEM ODD that this Presidential Address is my first publication in health economics. At the time when I might have been working on an alternative address, I was chair of an Expert Panel for the Advisory Council on Social Security looking at issues in both retirement income and medical care.2 In the process of this work, I have come up with a new approach to organizing universal health insurance. That is the subject of this paper. Before starting on health insurance, I will say a few words about a wider context, offering what I will say as an example in that setting.3 A great deal of attention has been focused on the exciting issue of reorganizing economies dropping central planning. Commonly, economists from those countries em- brace capitalism, or more specifically laissez-faire competition, with an enthusi- asm which exceeds that ofwestern economists, although not necessarily western businessmen. Yet laissez-faire capitalism has received little serious support in the West for a very long time. We all know the fundamental welfare theorem which shows many ways that capitalism can be imperfect. We have also seen a growth in discussion and analysis of the many ways governments can mess up resource allocation. The real question is the design of arrangements that try to integrate the things that each type of institution does better. This is hard for two reasons. One is that it is in the realm of second best with many constraints. The more the constraints the harder the analysis. The second is that we do not have good positive theories of government behavior. Good examples yes, good theories no. Thus the analysis is more intuitive, less theory driven than in our picture of private markets. But also in our private market analyses we have been greatly complicating our picture, recognizing all sorts of information imperfec- tions that affect the way that private markets work. So, I will present to you a proposal for universal health insurance meant to combine something that