Health-Care Reform: An Interview with Ira Magaziner

Article excerpt

National Forum: What are the most important problems the Clinton administration intends to address in its proposals for health-care reform?

Ira Magaziner: The fundamental thrust of the Clinton administration's plan for comprehensive reform of health care is security - creating for all Americans the security of knowing that they always will have adequate protection against the threat of illness, while controlling the runaway costs that threaten both our national economy and our health-care system.

NF: Are there reasons the Clinton administration is choosing not to adopt some of the main features of a Canadian-type system, with its guiding criteria for an "acceptable system"?

Magaziner: The Clinton administration's proposal will use the lessons that systems like Canada's can teach us but will tailor the American health-care system to America. Because ours is such a diverse nation, the Clinton plan will offer states flexibility to design their own health-care systems, working within the framework of providing security, controlling costs, and improving quality. A cornerstone of the Clinton proposal is increasing choice for all Americans-choice of doctor, choice of health plan, choice of hospital. We believe that in order to deal adequately with the health-care crisis we must design an American response to it.

NF: Will there be any effect on the insurance industry from the Clinton administration's proposals?

Magaziner: The Clinton plan will redefine health insurance in America, eliminating traditional practices, such as canceling policies when people get sick or raising their premiums exorbitantly. After reform, insurance companies will accept you whether healthy or sick. Right now, they can refuse to cover you if your daughter has asthma, but under the Clinton plan that can't happen. Also, it will give you the complete security that you will never lose your insurance if you switch or lose your job. Health reform will create a level playing field for individuals and small businesses that right now have no leverage with insurance companies to negotiate a good price for good health-insurance coverage. All of that will change under the new health-care system - Americans won't have to fear their insurance company or what their insurance might do to them.

In addition, all insurance claims will use a standard form, eliminating thousands of different forms with different rules and regulations used by insurance companies now. Under the Clinton plan, the insurance company's micromanagement of doctors and hospitals will stop, so more high-quality care may be delivered.

NF: Will there be an attempt to define the "basic unit" for providing health care in the Clinton administration, i.e., health-maintenance organizations (HMOs), health alliances, managed-competition units, etc.?

Magaziner: All Americans will have the choice of a variety of health plans. They can join a network of doctors and hospitals or an HMO, or they can continue to get care on a fee-for-service basis the way most people do now. Employers will no longer choose whether their employees go into a system of managed care or continue in the traditional fee-for-service. …