If our knowledge of the impact of existing programs and our knowledge of private expenditures on health and utilization of health services is incomplete, so, too, is out knowledge about the price elasticity for different income groups, and yet this is necessary information if we are to make any detailed projectors involving estimates of financing and their distributional impact. The purpose of a national health insurance program, if one examines the various proposals, is both amount of medical care received by some parts of the population. Yet, we lack information on relevant elasticities and, thus, on how much expansion might occur. It can be argued that it is difficult to make an accurate projection of the expansion of demand in a system that would look quite different from the existing system and in a situation with heavy emphasis on consumer education. Tastes would change and demand curves would shift. Nonetheless, it surely can be agreed that knowledge of the present elasticity of demand would be helpful.
1. Considerations In Evaluation Of Proposals.
It should be clear from the previous discussion that a detailed analysis providing refined estimates of the financial impact of a national health insurance program would require more information than is available about the present distribution of medical programs, and medical care costs. It would also require that the model be dynamic. The fact that we are unable to construct such refined estimates should, however, as I have already indicated, not be viewed as a great tragedy. Our concern at this conference is with basic principles and with an understanding of the directions that the various alternative plans would take. Even when the times come for intensive debate on national health insurance in the legislative branch of refinement, this will remain the proper concern, though the degree of refinement of estimates will, we would hope, increase. At that time it will be useful to have a model that is, in so far as possible, tied to data, a model in which the various assumptions concerning costs, total expenditures, types of coverage, etc. could be varied. The three issues discussed in the other papers, I suspect, will be far more critical to the adoption of a particular program than will financing impacts. Yet, such a model would alert us to inequities and would permit the details of a particular plan’s funding mechanism to be adjusted within the limits of political and other constraints.
For this conference, and at this stage in the debate concerning national health insurance ( a debate which at the national level is still addressed to the development of a consensus about the need for such a program rather than to the review of alternative mechanisms to achieve desired ends ) , we have been asked to assess, in so far as possible, the alternative plans along various axes. I have already referred to some of the variables that we should be cognizant of as we consider financing implications and which should be incorporated into any evaluation of the alternative plans. Let us examine these and other variables in greater detail and attempt to discuss them in the specifics setting of the alternative plans. We can then contrast the plans in qualitative terms in accordance with the criteria that are developed.
The summary of the various plans under review, prepared foe us by Mrs. Sue Moyerman of the Leonard Davis Institute of Health Economics, provides us with information on a number of the plans’ characteristics, including those which are of most direct interest for this paper on financing implications.
The proposed methods of financing the national health insurance program vary widely among the different proposals. It is useful to remind ourselves how great the differences are. Three plans ( Griffiths, Javits, CNHI-Kennedy ) call for employer and employee contributions based on taxable wages, as well as for contributions from general revenues
