The Healthcare Fix

The Healthcare Fix

Universal Insurance for All Americans

By Laurence J. Kotlikoff

A simple, straightforward, and foolproof proposal for universal health insurance from a noted economist.





A simple, straightforward, and foolproof proposal for universal health insurance from a noted economist.

The shocking statistic is that forty-seven million Americans have no health insurance. When uninsured Americans go to the emergency room for treatment, however, they do receive care, and a bill. Many hospitals now require uninsured patients to put their treatment on a credit card which can saddle a low-income household with unpayably high balances that can lead to personal bankruptcy. Why don't these people just buy health insurance? Because the cost of coverage that doesn't come through an employer is more than many low- and middle-income households make in a year. Meanwhile, rising healthcare costs for employees are driving many businesses under. As for government-supplied health care, ever higher costs and added benefits (for example, Part D, Medicare's new prescription drug coverage) make both Medicare and Medicaid impossible to sustain fiscally; benefits grow faster than the national per-capita income. It's obvious the system is broken. What can we do?

In The Healthcare Fix, economist Laurence Kotlikoff proposes a simple, straightforward approach to the problem that would create one system that works for everyone and secure America's fiscal and economic future. Kotlikoff's proposed Medical Security System is not the "socialized medicine" so feared by Republicans and libertarians; it's a plan for universal health insurance. Because everyone would be insured, it's also a plan for universal healthcare. Participants—including all who are currently uninsured, all Medicaid and Medicare recipients, and all with private or employer-supplied insurance—would receive annual vouchers for health insurance, the amount of which would be based on their current medical condition. Insurance companies would willingly accept people with health problems because their vouchers would be higher. And the government could control costs by establishing the values of the vouchers so that benefit growth no longer outstrips growth of the nation's per capita income. It's a "single-payer" plan, but a single payer for insurance. The American healthcare industry would remain competitive, innovative, strong, and private.

Kotlikoff's plan is strong medicine for America's healthcare crisis, but brilliant in its simplicity. Its provisions can fit on a postcard and Kotlikoff provides one, ready to be copied and mailed to your representative in Congress.


Out of Print ISBN: 9780262113144 128 pp. | 5.375 in x 8 in


  • Kotlikoff's book sends the strong message that all—not just the uninsured, the elderly, the middle class, or the politicians—are placing themselves and future generations in fiscal jeopardy through the current medical/financial free-for-all. Whether you agree with his solution or not, time is running out. Affordable medical care is everyone's problem. Most know John Donne's line, 'Send not to know for whom the bell tolls, it tolls for thee.' Fewer remember the more mundane words of the World War I trench ditty, 'The bells of Hell go ding-a-ling-a-ling for you but not for me...' The health care bells are ringing—not just for you, but for me. Read Kotlikoff's book, ponder his solution, and be warned.

    Markley H. Boyer, MD, DPhil, MPH

    Tufts University School of Medicine JAMA

  • Kotlikoff's passionate exposition of the details of his plan is sure to add to the growing health care debate.

    PW Web Exclusive Reviews

  • With the earnest tone of a teacher aching for his students to understand, Kotlikoff creates a stark picture of our looming financial straits.



  • Laurence Kotlikoff has done it again. He presents in his usual fast paced but understandable style, the immense financial problems faced by the Medicare and Medicaid programs. But he goes further, introducing and defending a complete solution. Whether or not you agree with his proposals, the importance of the question, and the brilliant defense of his solution, make this book a must read for both health policy professionals and interested citizens.

    Thomas R. Saving

    Trustee of the Social Security and Medicare Trust Funds,and Department of Economics, Texas A & M University

  • Almost everyone seems to agree that we are headed to a fiscal crisis in the United States, primarily because of the runaway cost of Medicare and Medicaid. However, almost no one clearly states what the problem is...until this book by Kotlikoff. Not knowing the full nature of the problem, most reform proposals are way off the mark in offering a solution. Kotlikoff does things in the right order. First, he lays out the problem and convincingly argues that the status quo is leading us to a catastrophe. Second, he offers a simple, yet radical, solution: universal health insurance vouchers for all Americans. In the long-run, his proposal would remain affordable, which is something that cannot be said for the status quo. This book is essential reading for anyone who wants to enter the debate about how to achieve universal health care and fiscal responsibility at the same time.

    John Shoven

    Charles R. Schwab Professor of Economics, Stanford University