SINGLE PAYERS AND MULTIPLE LISTS - MUST EVERYONE GET THE SAME COVERAGE IN A UNIVERSAL HEALTH PLAN

In spite of recent political setbacks for the movement toward universa l health insurance, considerable support remains for the idea. Among t hose supporting such plans, most assume that a universal insurance sys tem, especially if it is a single-payer system, would offer a single l ist of basic covered services. This paper challenges that assumption a nd argues for the availability of multiple lists of services in a univ ersal insurance system. The claim is made that multiple lists will be both more efficient and more fair. Any single list will fund some serv ices that are quite attractive to some people, but only marginally att ractive to others. Thus any single-list plan will fund some services t hat produce only marginal benefit for the resources used. Moreover, si nce some people will hold values quite compatible with the single list and others will hold values leading to preferences for unfunded servi ces, some people will get much more benefit from any single list than other people will. Fairness and efficiency require providing an entitl ement to universal access to health insurance that could be purchased by typical consumers for a fixed price of perhaps $3500. By permitting everyone to pick their preferred list of services available at that p rice, each person will efficiently use his or her entitlement while ge tting more equal opportunity for benefits.