Milbank Quarterly, Sept. 21, 2020 by Richard M. Scheffler & Taylor Wang

The full implementation of either the German or Australian system in the United States is implausible because we would need to overhaul the entire public insurance sector. However, these two systems have several components that can be adopted in any reform plan. First, universal coverage can be achieved with a robust two-tier public-private health care system. Second, though maintaining choice is integral to the US system, we will need ways to minimize the potential for biased risk-selection between the public and private sectors. Last, we need to highlight the necessity for equity when delivering a basic human right. Though each component will face considerable difficulty in implementation, all are integral to developing a successful public-private system committed to affordable, high-quality health care coverage.