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We need both universal health coverage and a more efficient delivery system. These are not competing objectives; achieving each of these goals is necessary to make the other possible. The most promising and politically feasible path to universal health coverage is to make an adequate level of insurance mandatory and affordable for all individuals.
The new system would be citizen-based instead of employer-based, thereby making health insurance fully portable from job to job. Once all patients are insured, providers can be expected to assist -- rather than resist -- the efficient redesign of our delivery system. This will entail an electronic health information superstructure, performance-based payments, and comparative technology assessment that will enable us to buy and deliver high-quality health care far more efficiently than we do today.
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