ABSTRACT
In terms of medical services, it would mean that everyone would get the same access to needed medical services up to the average expected life span. Oregon's Medicaid experiment shows the difficulty of sorting out who gets what and, in particular, shows the impossibility of beginning that process for a small part of the population, instead of for the population as a whole. The way out is to narrowly define medical services that are in the public interest, directly fund those services, and transfer the responsibility of deciding whether any other specific medical service is desirable to the individual. The high-deductible insurance component would help pay for discretionary costs once a person's medical expenses have exceeded a defined amount. Co-pays are an effective way to balance access, responsibility, and utilization – a concrete method of letting people know what things cost.
