ABSTRACT
The basic issues in health system reform and alternative reform proposals are the focus of this chapter. Many reform proposals face the dilemma whether to fund coverage by individual mandate, employer-employee mandate. Employer mandates form the backbone of the health systems in Europe, Latin America, and Asia. After World War II, employer contributions to health insurance were, and continue to be, tax-exempt, providing workers with a substantial discount and inviting inefficiencies of over-insurance and moral hazard. As support for universal coverage waned in Congress, more plans offered lesser goals for reaching the population. The most prominent single-payer proposal discussed in the US debates has been the Canadian Medicare system. The cornerstone of this strategy has been the promotion of health maintenance organizations (HMOs), preferred provider organizations (PPOs), and other forms of managed care. Medical tourism is a growing industry. Despite its focus on the uninsured, Patient Protection and Affordable Care Act (PPACA) affect almost every segment of the health economy.
