Covering the Uninsured-Searching for a Solution: Part 1 of a series

Not Easy

With state programs failing, a federal fix is tempting, but can also bomb, as Hillary Clinton discovered in 1993. Her plan, for consumers to buy coverage through HIPCs-government-sponsored purchasing coalitions-was dead on arrival.

Paul Ellwood Jr, MD, often cited as the father of managed care, explained: It is accurate to say that the revolution in health care started with us at the JHG, our health care leadership think tank. My intention was that health care organizations would compete on price and quality-managed competition. Instead, organizations were competing on price because consumers would change plans for five dollars a month.

The JHG’s plan was to ease into universal health care: cover seniors, then children, then everybody else. Mrs. Clinton’s arrogance in handling the process was astonishing. The JHG plan became the Clinton plan even before the president took office. Even though JHG developed the model for managed competition, the incoming administration acted with little input from us, said Dr. Ellwood.

Dr. Ellwood visited Mrs. Clinton, who wanted price controls to pay for universal coverage. I said that pushing controls would alienate the health care sector because prices were flattening, noted Dr. Ellwood. Mrs. Clinton said, ‘You’re wrong about this.’ Besides a certain incompetence on her part, she treated the health care sector as the enemy. Even though I spent my whole life working on this, she thought she had all the answers in a month of study. Her plan was dead and I knew it.

Dr. Ellwood continued: As to whether managed competition would ever lead to universal coverage, JHG was sharply divided. Had the Clinton administration not blown it, I believe that managed care, which already saved the country one trillion dollars, could fund health care for everyone. There would be even more money if the government eliminated corporate tax breaks for health benefits. (Piturro M. A healthcare conception. Managed Healthcare News 2000;16(8):1.)

Near Future

State and federal plans to extend health care coverage need a hard push to achieve a combination of reliable revenues, cost controls, marketing, affordability, and an attractive benefits package. A key element in any attempt to achieve universal coverage is that not everyone wants health insurance. Universal coverage advocates argue that since drivers must buy car insurance, why shouldn’t everyone have health insurance? The National Center for Policy Analysis says that 14.6% of drivers are uninsured; 15.7% of Americans lack health insurance. Even 9.2% of Hawaiians, who’ve had universal access since 1977, go bare. Forcing consumers to buy health insurance with employers, taxpayers, or providers footing the bill, seems problematic.