Cover

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Title Page, Copyright, Dedication

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Contents

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About the Author

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pp. ix-x

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Preface

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pp. xi-xii

Since the mid-1970s, the federal government has conducted nationally representative surveys of the U.S. population to learn more about those who do not have health insurance. Twenty-five years ago two-thirds of the uninsured lived in poverty or had incomes just above the poverty level, and two-fifths were children. For policymakers determined to reduce ...

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Acknowledgments

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pp. xiii-xvi

As my family and friends know all too well, Reinsuring Health has been a long time coming. I wrote this book with the hope that it would contribute to the public's understanding of why so many Americans are uninsured and what might be done to remedy the situation. I would dearly like to see this great country develop a policy that would guarantee ...

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Chapter 1. A Health Insurance System in Crisis?

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pp. 1-12

Susan Mitchell* does not have health insurance. She is a freelance editor and writer who until three years ago was an employee of a medium-sized company in Washington, D.C. Health insurance had been part of her compensation. Susan writes public relations announcements and edits documents that are sent to the firm's clients. When the ...

PART I. Why People Lack Health Insurance

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pp. 13-14

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Chapter 2. The Growing Ranks of the Insured: Who Lacks Health Insurance?

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pp. 15-43

If you want to have a career in broadcasting, journalism, advertising, graphic design, filmmaking, or interior design, prepare to live without health insurance. Even many high-tech computer-related occupations, such as software programming, hold out the same prospect. None of this was true twenty-five years ago—but when it comes to health ...

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Chapter 3. Why Employer-Group Health Insurance Is Cheaper—and Why Those Who Have It Are Lucky

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pp. 44-59

What is it about employer groups that insurance companies find attractive? How did it come to pass that the United States has an employer-based health insurance system? In 2004, 63 percent of Americans under age sixty-five obtained health insurance through their own or a family member's employer, down from 67 percent in ...

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Chapter 4. How Health Insurance Markets Work

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pp. 60-82

Health insurance is different from most of the goods and services we buy each week. The price of a half-gallon of milk or a sweater does not depend on who buys it. But the costs of producing and purchasing health insurance depend in large part on who buys it and who belongs to a group that buys it. ...

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PART II. Public Policies to Make Private Insurance More Available

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pp. 83-84

The need for government policies to help small firms and individuals obtain health insurance is urgent. But policies focused only on providing subsidies to help people purchase private insurance are inadequate because the fail to address the way insurers respond to adverse selection in the individual and small-groups markets. In this part ...

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Chapter 5. Two Approaches: High-Risk Pools and Assessments to Cover High-Risk People

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pp. 85-100

We need to devise a policy approach that substantially reduces insurers' risk of extremely high expenditures. The cost of using selection mechanisms will then exceed their advantages for insurers. Moreover, if the expenses of very high-cost people are spread among the total population, low-risk people will not face significantly ...

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Chapter 6. A Third Approach: The Government as Reinsure rfor Small-Group and Individual Markets

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pp. 101-122

Almost all insurers purchase reinsurance to protect themselves from low-probability but very costly events that could force them into bankruptcy. The hurricane seasons of 2004 and 2005 provide good examples of financial disasters that occasionally befall property and casualty insurers with a large proportion of their business in Florida ...

PART III. Getting from Here to There

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pp. 123-124

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Chapter 7. The Need for a New Health Insurance Structure

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pp. 125-136

The American system of health insurance is in trouble. Since at least the 1950s, the country has had a health insurance structure that relies on the vast majority of people having insurance as part of employment compensation. The expectation has been that as the economy grew and the country prospered, more and more workers and their ...

Appendix. Precedents for Government Assuming Responsibility for the Worst Risks

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pp. 137-148

Notes

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pp. 149-180

References

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pp. 181-192

Index

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pp. 193-203