The problem with the private health insurance system in the United States is that sick people without insurance can’t find affordable policies. Covering the uninsured pays for itself by providing preventive care and reducing expensive emergency room care. Lack of insurance is the principal barrier to getting high-quality care.

All of these statements represent “facts” that many people “know” about the American health insurance system, but all of them are also myths, Katherine Baicker and Amitabh Chandra of Harvard write in one of two articles published Oct. 21 on the Health Affairs Web site. In the second article, Jonathan Oberlander of the University of North Carolina analyzes the politics of paying for health care reform.

According to Baicker and Chandra, other health insurance myths include the ideas that employers can shoulder more of the burden of paying for insurance and that high-deductible health plans and competition — not government action — are the keys to lower costs. “These myths are each built on a kernel of truth, but the oversimplified form in which they are often presented by advocates can be quite misleading. We hope that stripping these myths away will help reveal the real problems of our insurance system and prepare the public for the hard trade-offs that meaningful health care reform will require,” said Baicker, a professor of health economics at the Harvard School of Public Health.

Oberlander considers the political pros and cons of four main strategies for financing health care reform. First, he discusses the “holy grail” of financing possibilities: ending the tax exclusion for employer-sponsored health benefits, which could produce $3.6 trillion over the next decade. Next, he examines the “zombie” of mandating that employers provide coverage to their workers, which has been a feature of many unsuccessful reform attempts, only to reemerge repeatedly in new proposals.

Third, Oberlander looks at financing health reform through a value-added tax, a broad-based consumption tax that is common in other industrialized countries but has not been used in the United States. And finally, in contrast to the VAT, an approach that he dubs “the foreigner,” Oberlander discusses the “all-American” approach of financing health reform through general revenue. “There are no easy paths to financing universal coverage,” Oberlander warns.

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