HKS Authors

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I was gratified to see Liran Einav and Amy Finkelstein write, “if Furman and others like him are enthusiastic about trying to build momentum for a proposal for universal, automatic, basic coverage with income-related cost-sharing and the option to supplement it, we would be happy to pull up stakes and declare victory.” But I am worried that there may not be many others like me so we might be up to three people out of 300 million now in strong support of the Einav-Finkelstein-Furman plan. But before getting back to feasibility, let us talk a bit more about the substance. Is it a good idea to have a health insurance plan floor that ends up with the majority of people getting coverage on top of it? I am genuinely unsure. In the case of Medicare it is clearly the result of the flawed program design, one reason why I was pleased that Einav and Finkelstein neither called their plan “Medicare for All” nor designed it based on Medicare. Medicare is not genuine insurance in that some coverage maxes out and is effectively uncapped. It subjects you to intolerable risk unless you get Medicare Advantage, Medigap, or combine with another plan like employer-sponsored insurance or Medicaid. That is why 90% of people do not rely solely on Medicare.


Furman, Jason. "Which direction should we head to get to our North Star?" Journal of Policy Analysis and Management (April 30, 2024).