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For all of our talk of healthcare as an individual resource, “my healthcare”, it is actually a group resource, a shared risk pool like any other kind of insurance. And like any other kind of insurance there has to be a limit to the group’s liability – no group health plan can afford to pay an unlimited amount of money for any person’s care. This question, “How much can we afford to pay to keep any one person alive?” as harsh as it is, has to be answered. If we don’t trust insurers and employers to strike the balance, then we need to let the group members themselves decide – we need to let the members of the tens of thousands of group health plans take control of the annual plan decisions and decide the proper balance between cost and coverage.

This paper makes the case for allowing self-managed healthcare groups within our existing healthcare system, for allowing the members of group health plans to take control of the annual plan decisions that are currently made by their employer or insurer. With that control they can make the same broad decisions employers make annually on the boundaries of coverage and also on the appropriate limits on liability for the group.

This paper also suggests that self-managed healthcare groups in conjunction with an approach to funding referred to as a Fixed Tax Credit offer a realistic path to transforming our healthcare system to insure equitable, universal coverage for all. The Fixed Tax Credit approach would change the funding mechanism but not the structure itself, fitting into our existing healthcare system with minimal upheaval or disruption. It won’t solve every healthcare issue facing our country, but would be a significant step towards meaningful healthcare reform.

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