Consumer-Choice Health plan (second of two parts). A national-health-insurance proposal based on regulated competition in the private sector

N Engl J Med. 1978 Mar 30;298(13):709-20. doi: 10.1056/NEJM197803302981304.


Medical costs are straining public finances. Direct economic regulation will raise costs, retard beneficial innovation and be increasingly burdensome to physicians. As an alternative, I suggest that the government change financial incentives by creating a system of competing health plans in which physicians and consumers can benefit from using resources wisely. Main proposals consist of changed tax laws, Medicare and Medicaid to subsidize individual premium payments by an amount based on financial and predicted medical need, as well as subsidies usable only for premiums in qualified health insurance or delivery plans operating under rules that include periodic open enrollment, community rating by actuarial category, premium rating by market area and a limit on each person's out-of pocket costs. Also, efficient systems should be allowed to pass on the full savings to consumers. Finally, incremental changes should be made in the present system to alter it fundamentally, but gradually and voluntarily. Freedom of choice for consumers and physicians should be preserved.

MeSH terms

  • Community Participation
  • Comprehensive Health Care
  • Costs and Cost Analysis
  • Delivery of Health Care
  • Financing, Government
  • Financing, Personal
  • Health Expenditures
  • Health Maintenance Organizations
  • Humans
  • Income Tax
  • Insurance, Health / economics
  • Medicaid
  • Medical Indigency
  • Medicare
  • Middle Aged
  • National Health Insurance, United States / economics*
  • National Health Insurance, United States / legislation & jurisprudence
  • United States