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Book and Media Reviews
April 1, 2009

Healthcare, Guaranteed: A Simple, Secure Solution for America

JAMA. 2009;301(13):1384-1389. doi:10.1001/jama.2009.385

In Healthcare, Guaranteed: A Simple, Secure Solution for America, Ezekiel Emanuel argues that the US health care system requires comprehensive reform. Incremental reform—Medicare and Medicaid, for example—has done more harm than good because it “preempted comprehensive reform that could have made a real difference” (pp 120-121).

Ezekiel Emanuel and Victor Fuchs (who wrote the foreward to this book) have been advocating a Guaranteed Healthcare Access Plan (GHAP) since 2005. Under this plan, the federal government would send a voucher to every US citizen. The vouchers would entitle everyone to the same health benefits as members of Congress. Health insurance plans would be required to cover each person with a voucher as well as persons assigned to these plans because they did not select a plan. A federal agency would pay a risk-adjusted insurance premium in exchange for each voucher submitted. Patients would choose their physicians and other clinicians, who would be organized into networks by health care systems and insurance plans. The GHAP would be financed by a dedicated sales tax, immediately eliminating employer-based coverage and gradually replacing Medicare, Medicaid, and the State Children's Health Insurance Program. It would be governed by a National Health Board and a dozen regional boards. An Institute for Technology Outcomes and Assessment would “ensure that we spend money only on those healthcare tests and treatments that truly improve the quality and length of life” (p 11). Centers for patient safety and dispute resolution would “solve the malpractice mess” (p 11).