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August 17, 1994

Health System Reform: A Different Approach

Author Affiliations

From the Departments of Economics and Health Research and Policy, Stanford University, and National Bureau of Economic Research, Stanford, Calif.

JAMA. 1994;272(7):560-563. doi:10.1001/jama.1994.03520070080044

Early in his administration, President Clinton placed health system reform at the top of the nation's domestic policy agenda. Since then proposals from all parts of the political spectrum have proliferated. Many of these proposals are embodied in specific legislation now under consideration by Congress. Unfortunately, none of the proposed plans will finance coverage efficiently and equitably and slow the rate of growth of health care spending while providing the flexibility, freedom of choice, and improvement in quality that is desirable and feasible. In my judgment, a different approach is needed to achieve these objectives. I believe we must develop a national financial plan to cover basic care for all, accelerate the present trend toward integrated health care systems, attack directly the major causes of increased health care spending, and completely change the nation's policy regarding malpractice. The approach outlined herein consists of five interrelated components.

A Value-Added Tax Earmarked