For decades US policymakers have tried to achieve the universal health insurance coverage that many other developed countries enjoy. But despite incremental reforms, based on tweaking health insurance markets, America's uninsured population has remained stubbornly high.

In a paper in the Journal of Economic Perspective, authors Katherine Baicker, Amitabh Chandra, and Mark Shepard argue that economists should move away from the paradigm that has inspired these past reforms and toward an approach that encourages wholesale change. They say that proposals should start from a basic, mandatory health insurance package, which can then be supplemented in markets for health insurance.

Shepard recently spoke with Tyler Smith about the success of health care systems using this framework in other developed countries and why economists need to rethink their approach to health insurance reform in the United States.