Are we better off without health reform? - Editorial

I agree with Rush Limbaugh on one point. After more than a year of closely examining every possible health reform plan from the most ambitious to the most incremental, I now think we should--as Rush says--fix only the 15% of the system that doesn't work. We should leave the other 85% alone.

Having said that, I also believe that President Clinton deserves high praise for his efforts to reform the system from the top down. Simply putting the issue before Congress, as Clinton did, forced providers and buyers nationwide to change how they do business.

"I don't think there's any doubt that Clinton changed health care in this country," says Patrick J. Casey, executive director of the Health Action Council of Northeast Ohio, an employer coalition. But political reform---or any plan from Washington that would reform the system from the top down--may no longer be needed except to provide health coverage for those 15% who can't afford it or can't get it at any price.

Instead of reform being mandated from Washington, what's happening is providers and buyers are finding ways to control costs and to improve quality and access in markets across the country, says Casey. "Reform is happening. And the changes are stunning."

HMOs are merging with other managed care organizations, hospitals and doctors are forming alliances, and hospitals are merging with and affiliating with each other. In Northeast Ohio, only one or two out of 31 hospitals are unaffiliated, Casey says.

But even with these changes, there is a danger that if health care buyers and consumers do not articulate their vision for health reform in each market, the providers will, Casey says. In the absence of pressure from buyers, providers will dictate the terms. That's not necessarily bad, but it could leave employers and consumers powerless, he says.

"In Cleveland, we articulated a vision and that drove some of the changes we're seeing," he says. But it's not as easy as simply drafting a vision. "The clearest voice of what purchasers want is how they buy." With that idea in mind, Ohio employers are doing what health care buyers in other parts of the country are doing: They are preparing a group purchasing plan tailored to their particular market. In other words, they are reforming the market to suit their needs.

So, are we better off without health reform? Yes and no. No, because 15% of Americas still lack health insurance. Yes, because the reform movement has forced employers and providers to bring about reform on their own. Now, employers must use their buying power to negotiate the terms best suited to the needs of their markets. Without a concerted employer effort, reform will be foisted upon them.

COPYRIGHT 1994 A Thomson Healthcare Company
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