residents, Benson delineates the features of a successful program for managed care consumers.
Gage argues in Chapter Sixteen that the debate over managed care regulation ignores the more fundamental problem of the growing number of uninsured. Absent national universal coverage, Gage advocates strengthening safety net programs for the uninsured, such as Medicare and Medicaid's Disproportionate Share Hospital (DSH) programs for high-volume providers of care to the uninsured.
One of the greatest controversies in the managed care reform debate has been over how much cost the various regulatory provisions would add to health insurance. In Chapter Nineteen, Dobson and Steinberg of The Lewin Group, which produced one of the most widely cited estimates, analyze the substantial differences between the various cost projections. For example, the estimates produced by the consulting firm Milliman & Robertson and the accounting firm Coopers & Lybrand of the proposed federal Patient Access to Responsible Care Act (PARCA) varied by a factor of thirty. Dobson and Steinberg note that differences in key assumptions about how a particular legislative provision would be implemented significantly affected the cost estimates, as did the degree to which indirect effects were considered.
Two chapters consider aspects of the managed care debate related to the ERISA statute. Copeland and Pierron (Chapter Ten) explain ERISA's preemption of state laws governing group health plans. Keepnews (Chapter Nine) examines proposals to hold managed care plans legally liable for harm caused to patients. He analyzes the complex legal issues involved, and he describes both state and federal legislation to evade or amend ERISA's restrictions.