Amy Finkelstein thinks she can fix U.S. health care. The Massachusetts Institute of Technology economics professor and MacArthur “genius grant” fellow is the author of a new book with Liran Einav: We’ve Got You Covered: Rebooting American Health Care. It argues that piecemeal policies can’t correct our current system. Their solution: Universal coverage. Enrollment would be automatic. Basic care would be free. And no one would lose insurance if they left their job or earned enough to rise above the poverty line. Americans could still buy an extra layer of private health insurance — something the authors envision two-thirds of Americans doing. Erin caught up with Finkelstein to learn more. This interview has been edited for length and clarity. What problem are you trying to solve? Health insurance is not delivering on its function. Over 1 in 10 Americans under 65 are uninsured at any given moment, and of the 30 million Americans who are uninsured, 6 in 10 are eligible for free or heavily discounted health insurance coverage. And yet they don’t have that coverage. Even people fortunate enough to not only have insurance, but to maintain that health insurance coverage, can face catastrophic medical expenses when they get care that’s supposedly covered. Not only is an enormous amount of medical debt held by the public, but most of it is incurred by households that have health insurance. What would your plan cover and how would it compare to what we have now? Primary care, preventive care, surgical procedures, essential medical treatments, hospitalizations, urgent, non-urgent and emergency care would be covered. But there’s a lot of things it won’t cover. There will be longer wait times for non-urgent care than people with private insurance currently experience, more like the wait times in the current Medicaid program for low-income individuals. Second, there will be less choice compared to what people with traditional Medicare coverage have now: any procedure they want with any choice of doctor. There will be versions of gatekeeping and care management. Can you envision a Congress that will approve a plan like yours? Yes. In every country that adopted universal, basic coverage, it was an enormous political struggle. As the political climates change, as they always and often do, and new policy windows open, we’re clear-eyed and ready with what we want to accomplish. The standard dialogue, in which every other high-income country was destined to have universal health insurance but the U.S., because of our unique political culture or the power of the American Medical Association or lack of a powerful labor movement, is just a gross misreading of history. | 
