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Compromise |
PROLOGUE
Formulas For Compromise
The system must change. The system cannot change. These seem to be the lessons of policy analysis and policy initiative, of repeated recommendations and oft-frustrated efforts to improve access, moderate cost, enhance quality, and encourage innovation in health insurance. The political imperative is to ascertain how much can be reformed with the least disruption of existing institutions and expectations.
The following papers describe the elements they interpret as essential for health insurance reform while leaving as much as possible of the larger system remain in place, at least for now. Cathy Schoen and her colleagues at the Commonwealth Fund, which is focusing much of its work on promoting a "high-performance health system," advocate a combination of individual insurance mandate, modest employer tax, expansion of public programs and tax credits, and a "connector" structure that offers individuals and small firms a choice of coverage between private insurance and a Medicare-sponsored plan.
Katherine Baicker of Harvard University seeks a "formula for compromise" that would uphold the cultural importance of individual choice but channel it toward forms of care and coverage that offer the best combination of cost and performance; for Baicker, as for most economists, it’s all about trade-offs.
Bruce Bodaken, chairman, president, and chief executive officer (CEO) of Blue Shield of California; and Paul Ginsburg, president of the Center for Health System Change, focus attention on the roles of insurers and employers, respectively, in the debate over and creation of a reformed health care system. Both emphasize the willingness of these stakeholders to cooperate in system reform and take leadership positions in reform efforts, to the extent that the new system builds on the strengths of the current structure and focuses change on its weaknesses, rather than throwing everything into the air and provoking a backlash of political fear and economic self-interest.
A Perspective by Andy Stern, president of the Service Employees International Union (SEIU) since 1996, follows the Ginsburg paper. He and Safeway CEO Steve Burd have worked closely with Sen. Ron Wyden (D-OR) and Sen. Bob Bennett (RUT) on the bipartisan Healthy Americans Act, which is the subject of another Perspective in this volume by Senators Wyden and Bennett.
Related Articles
- Cathy Schoen, Karen Davis, and Sara R. Collins
Building Blocks For Reform: Achieving Universal Coverage With Private And Public Group Health Insurance
Health Affairs, May/June 2008; 27(3): 646-657.
[Abstract] [Full Text] [PDF]
- Katherine Baicker
Formula For Compromise: Expanding Coverage And Promoting High-Value Care
Health Affairs, May/June 2008; 27(3): 658-666.
[Abstract] [Full Text] [PDF]
- Bruce G. Bodaken
Where Does The Insurance Industry Stand On Health Reform Today?
Health Affairs, May/June 2008; 27(3): 667-674.
[Abstract] [Full Text] [PDF]
- Paul B. Ginsburg
Employment-Based Health Benefits Under Universal Coverage
Health Affairs, May/June 2008; 27(3): 675-685.
[Abstract] [Full Text] [PDF]
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