National Health Insurance: An Idea Whose Time Has Come?

Private and public health insurance programs by their selectivity of coverage and means of payment add to the fragmentation and inefficiencies of the health care sector. The proposals for the establishment of some form of national health insurance presented in the more than forty bills before Congress incorporate a wide range of approaches to financing, benefits, accountability, and regulation. This paper elucidates the key policy variables in terms of whose dimensions the dif ferent proposals may be analyzed, and some criteria for evalu ating their different aspects. The three major proposals—by the Nixon Administration, Senator Edward Kennedy, and the American Medical Association—are detailed and their probable effects discussed. The choice is not between financing mecha nisms as such but rather between different systems for provid ing medical care. Although none of the proposed plans would assure equal access to needed care for all, the Kennedy Plan goes furthest in that direction.