Magazine article Insight on the News

Changes in Marketplace Should Guide Health Care

Magazine article Insight on the News

Changes in Marketplace Should Guide Health Care

Article excerpt

Although Congress is now talking about reform on a smaller scale, many of the actual proposals to create a national health-insurance program resemble President Clinton's "Health Security Act." To provide insurance coverage for all Americans, the president recommended the institution of new bureaucratic arrangements to make the delivery of care more efficient and to control costs. The president's vision is not limited to providing services to those without access; he wants to structure a health care-delivery system with extensive regulations, one that would abandon much of what has made American health care the best in the world. Such sweeping change, by increasing the power of government over our existing private-delivery system, would not be smart.

Many reform proposals want to see American health care organized into competing delivery systems. Insurance companies, health maintenance organizations, or HMOs, and groups of providers could organize and offer themselves for governmental approval as "health plans." Officially certified systems would be able to offer coverage as long as they provided the government-approved package of benefits for a set price, usually a modified average for the region.

The amount individuals are willing to pay for their share of the premium not paid by their employer, plus varying deductibles and copayments, would determine their coverage. The HMO with fewest choices will cost the least. The rationale for this is that fee-for-service, free-choice medicine is costlier than organizationally delivered care. Cafeteria plans that offer choices based on the needs of individual workers would not be permitted.

During the past 10 years, the marketplace has changed. Health-cost escalation has moderated and employers have been demanding more cost-control measures from their insurance carriers and health care providers. Slowly and effectively, new ways of providing and managing care to employed populations are emerging. Employers have been active in forming coalitions to purchase health care and aggressively changing their benefits packages to control costs.

To be sure, managed care, in one form or another, is here to stay. Fee-for-service health plans will undergo reviews for excessive use of services. …

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