We’ve Got You Covered: Rebooting American Healthcare

The U.S. health-care system, according to Einav and Finkelstein, cannot just be repaired; it needs to be torn down. Many expensive patches have produced more problems than they have fixed. Since health care accounts for just under one-fifth of the country’s GDP, this is a mountainous claim. The authors are not principally concerned with the plight of the 27 million or so uninsured Americans but rather the other 90 percent of Americans who do have health insurance but are underinsured, drowning in medical debt, or tied by their insurance to jobs they want to leave. In this system, both the sick and the healthy spend endless unproductive hours navigating the tortuous and often cruel maze of insurance bureaucracy. On a broader level, the U.S. health-care system operates without a budget and spends 50 to 100 percent more per capita than many European and Asian systems that produce better outcomes (including lower infant mortality, less time spent in the hospital, shorter wait times, and so on). In an eminently readable account, the authors argue for a wholly new approach consisting of genuinely universal, free, basic care overlaid with the option to buy fancier supplemental care: to provide, in short, adequate treatment for all if not complete equality.