President Clinton has proposed a managed competition model for health care reform. This strategy would accelerate the corporatization of U.S. health care resulting in more bureaucracy, less patient choice, and a health system owned by a few insurance giants. There is no evidence that competition or other central features of Clinton's plan can lower costs or improve quality. Because cost containment is doubtful, the promised expansion of coverage is unlikely to be implemented.
Get full access to this article
View all access options for this article.
References
1.
LinkW.Prudential Insurance Company Newsletter, 1993.
2.
Health Security Act. U.S. Government Printing Office, Washington, D.C., 1993.
3.
HimmelsteinD. U.The Growing Epidemic of Uninsurance: New Data on the Health Insurance Coverage of Americans. Center for National Health Program Studies, Cambridge, Mass., 1992.
4.
HimmelsteinD. U.WoolhandlerS. Unpublished tabulations from Current Population Surveys, March 1994.
5.
SagerA.HiamP.SocolarD.Promise and Performance: Report of the Access and Affordability Monitoring Project. Boston University School of Public Health, Boston, 1989.
6.
Organization for Economic Cooperation and Development. OECD Health Data: Comparative Analysis of Health Systems—version 1.5. Computer data base. Paris, 1993.
7.
RiceT.BrownE. R.WynR.Holes in the Jackson Hole approach to health care reform. JAMA270: 1357–1362, 1993.
LevitK. R.Health spending by state: New estimates for policy making. Health Aff. 12(3): 7–26, 1993.
10.
InterStudy. Managed Care: A Decade in Review. St. Paul, Minn., 1993.
11.
PearR.Health care spending is found to vary greatly state by state. New York Times, October 7, 1993, p. A12.
12.
Congressional Budget Office. The Potential Impact of Certain Forms of Managed Care on Health Care Expenditures. CBO Staff Memorandum. Washington, D.C., August 1992.
13.
GabelJ. R.Witness to a thousand stories: A look at insurance data. Health Aff. 11(4): 186–190, 1992.
14.
Congressional Research Service. The Federal Employee Health Benefits Program: Possible Strategies for Reform. U.S. Government Printing Office, Washington, D.C., 1989.
15.
KramonG.Insurers move into the front lines against rising health-care costs. New York Times, August 25, 1991, p. A1.
16.
BerkM. L.MonheitA. C.The concentration of health expenditures: An update. Health Aff. 11(4): 145–149, 1992.
17.
LuftH. S.Health maintenance organizations and the rationing of medical care. Milbank Mem. Fund Q. 60: 268–306, 1982.
18.
HellingerF. J.Selection bias in health maintenance organizations: Analysis of recent evidence. Health Care Financ. Rev.9(2): 55–63, 1987.
19.
U.S. General Accounting Office. Medicare: PRO Review Does Not Assure Quality of Care Provided by Risk HMOs. Washington, D.C., 1991.
20.
FritschJ.Erroneous report by health insurer aided legal fight. New York Times, June 18, 1993, p. B1.
21.
IMC chief convicted of fraud, bankrupt HMO owes $12 million. McGraw Hill's Med. Health40(50): 2, December 21, 1987.
22.
Are HMOs the answer?Consumer Rep., 1992, pp. 519–531.
23.
DowMarion Merrell. Managed Care Digest: HMO Edition. Kansas City, Mo., 1993.
24.
StarrP.The framework of health care reform. N. Engl. J. Med.329: 1666–1672, 1993.
25.
EpsteinA. M.Changes in the delivery of care under comprehensive health care reform. N. Engl. J. Med.329: 1672–1676, 1993.
26.
ReinhardtU. E.Comment on the Jackson Hole Initiatives for a Twenty-first Century American Health Care System. Health Econ. 2: 7–14, 1993.
27.
KronickR.The marketplace in health care reform: The demographic limitations of managed competition. N. Engl. J. Med.328: 148–152, 1993.
28.
WoolhandlerS.HimmelsteinD. U.The deteriorating administrative efficiency of the U.S. health care system. N. Engl. J. Med.324: 1253–1258, 1991.
29.
LetschS. W.National health care spending in 1991. Health Aff. 12(1): 94–109, 1993.
30.
SheilsJ. F.YoungG. J.National Health Spending under a Single Payer System: The Canadian Approach. Staff Working Paper. Lewin/ICF, Fairvax, Va., 1992.
31.
ShoorR.Moving health care data electronically. Business Health10(12): 38–45, 1992.
32.
WoolhandlerS.HimmelsteinD. U.LewontinJ. P.Administrative costs in U.S. hospitals. N. Engl. J. Med.329: 400–430, 1993.
33.
RosenthalE.Insurers second-guess doctors, provoking debate over savings. New York Times, January 24, 1993, p. A1.
34.
WareJ. E.Comparisons of health outcomes at a health maintenance organization with those of fee-for-service care. Lancet1: 1017–1022, 1986.
35.
KassirerJ. P.The quality of care and the quality of measuring it. N. Engl. J. Med.329:1263–1264, 1993.
36.
Mod. Healthcare, February 1, 1993, p. 24.
37.
HartJ. T.Two paths for medical practice. Lancet2: 772–775, 1992.
38.
PriestD.Health care theorists of Jackson Hole: Policy heroes or special interests?Washington Post, March 12, 1993, p. A15.
39.
RubinH. R.Patients' ratings of outpatient visits in different practice settings. JAMA270: 835–840, 1993.
40.
HimmelsteinD. U.A national health program for the United States: A physicians' proposal. N. Engl. J. Med.320: 102–108, 1989.