THE growing prominence of the ways business and government
budgets are straining to support the health-care system is
heightening the urgency of calls for a program to control its costs.
A sense of crisis may be necessary to forge the difficult
consensus needed to act on overhauling the health-care system,
according to Gregory Schmid, a senior research fellow at the
California-based Institute for the Future, which forecasts
long-term policy shifts.
Signs indicate that such a consensus is beginning - crudely - to
The Clinton transition team for health-care issues has met with
key senators and representatives and confirmed ambitious plans to
submit a comprehensive health-care reform plan to Congress within
100 days of President-elect Clinton's Jan. 20 inauguration, and to
pass it into law by the end of this year.
The impetus to control costs, however, appears to be outpacing
the will to expand access to health care to the 37 million
Americans currently either without health insurance at all or with
policies that do not provide enough coverage.
The Clinton team does not plan to overhaul the health system
without offering everyone access to it - a principle of the Clinton
health-care platform was that everyone has a right to it. But
access costs money.
The way in which the overhaul is eventually phased in, if it
becomes law, can give priority either to the economic discipline of
controlling costs or to the social goal of expanding coverage.
The consensus thus far centers around the concept of managed
competition, which builds on the job-based health-insurance system
now in place. Little consensus has formed, however, on how managed
competition should work.
One way is to limit the amount employers or employees can deduct
from their taxes for health-care costs. The theory is that this
could introduce some market pressure on health-services prices now
insulated by tax deductions. A common objection among the many
opponents of this approach, however, is that it raises taxes on the
Even strong supporters of managed competition, such as the
Clinton campaign, are not sure that it will work to hold down costs.
The transition team has a "healthy skepticism about its
prospects," says Jack Hadley, co-director of the Center for Health
Policy Studies at Georgetown University. The other co-director is
the Clinton transition director of health issues, Judith Feder.
"Managed competition is untried, untested," a Senate aide says. …