Letters to health-care Santa: Fix the exchanges!
Over the course of this week, I'll be asking some health-care experts what they'd like Santa to add to the bill during conference committee and publishing their responses on the blog. Next up is Alain Enthoven, the Marriner S. Eccles Professor of Public and Private Management, emeritus, at Stanford University. Known as the "father of managed competition," his ideas were central to the Clinton process in the early '90s, and his research on the financing and delivery of health care in the United States and other industrialized nations, and cost-benefit analysis in medical care, have influenced a generation of policymakers and academics.
I would say that there ought to be a serious attempt to introduce competition of delivery systems to serve cost conscious consumers -- something that works well at a small scale for State employees in CA and WI -- extending the concept to all individuals and also employees of groups up to 100 employees. The exchanges through which these consumers would choose need to be large enough to have market impact, and also a strong design to prevent adverse selection against the exchanges. One way would be to require all insurers to practice community rating (same price for everyone buying the same coverage) for the whole market from individuals up to groups of 100. That would make the market work the way it did when it was dominated by nonprofit Blue Cross and plans like Kaiser and Group Health Cooperative. Within rules, let consumer choice drive the important tradeoffs in system design.
Enthoven also recommends people read this memo (pdf) he authored on the design of the exchanges. The current Senate exchanges will fail, he believes, but with some modest changes, they could succeed.
Earlier in this series, Diane Archer called for Congress to create national exchanges rather than state exchanges.
Posted by: wisewon | December 22, 2009 11:09 AM | Report abuse
Posted by: jkaren | December 22, 2009 11:11 AM | Report abuse
Posted by: staticvars | December 22, 2009 1:11 PM | Report abuse
Posted by: petermilley | December 22, 2009 3:57 PM | Report abuse
Posted by: HalHorvath | December 23, 2009 3:52 PM | Report abuse
The comments to this entry are closed.