Continue Moving Forward on the Affordable Care Act Path.

Abstract

For more than 30 years, Stuart Butler has been one of a small band of market-oriented health policy analysts advocating for a universal health care system in the United States Butler s enduring vision, a coherent program grounded in health economics, calls for replacement of the current tax exclusion for employersponsored insurance premium payments with a sliding-scale tax credit;a marketplace of competing private insurers selling plans covering a federally prescribed basic set of benefits;and a mandate requiring all individuals to purchase health insurance 1,2 It has been strikingly influential;many of its core elements are-or were-reflected in features of the Affordable Care Act (ACA) Incremental steps- increasing the generosity of subsidies in the marketplaces, offering marketplace coverage to a larger share of those with costly employer-based coverage, and promoting expansion of Medicaid in the 12 states that have not yet done so, all of which are components of the Biden health plan-would go a long way toward addressing these immediate concerns 4 Fundamentally, however, these problems stem from the fact that US health care costs are excessive, and a growing consensus finds they are excessive because prices in our health care system are excessive 5 Liberal health policy analysts suggest that some form of direct government intervention in pricing is needed-either in the form of establishing backstop prices, as the Medicare fee-for-service program does for Medicare Advantage;through direct regulation or negotiation, as in other countries with market-based systems;or through public health insurance programs