This article reviews and comments upon the Institute of Medicines recent call for universal health insurance and the four options IOM puts forward for getting there. The authors focus their comments on complications that arise in pursuing some of those options, involving benefits and geographic variations and costs. The complications suggest that the IOM's cost estimates may be too low and that there may be sizable political barriers to the proposals. (Health Affairs March/April 2004 - Volume 23, Number 2
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