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A pair of proposals on health care reform.

Health care, long the domain of the medical and risk management communities, is now a major political football being tossed around the headlines. All sides of the political spectrum agree that the nation's health care system needs reform, but that's where the common ground ends. Two approaches to the problem were presented by an incumbent New England governor and a major conservative think-tank during the recent Northeast Managed Health Care Congress.

Howard Dean's expertise on the subject comes from being governor of Vermont, which boasts a comprehensive state health care systems, and his experience as a physician. His advise was more local than national: Create a single "health care authority" for Vermont and don't wait for Congress or the White House to come to the rescue.

Gov. Dean's proposed health care authority would reaffirm the state's commitment to unviversal health care access while setting standards for the minimum level of coverage. "It will tell the insurance companies what they can charge," he said of the proposed authority. "We will go to them with a plain vanilla benefits package that everyone gets. If they want to add to it, that's their business."

The proposed authority would also implement managed care programs, develop mechanisms to discourage inappropriate or unnecessary medical care and testing and increase efforts to promote good health. The governor was reluctant about giving a single payer free reign of the state, preferring three to five insurers willing to insure all interested consumers and able to negotiate with hospitals and doctors.

The crisis facing the health care system was not the result of a carefully constructed plan gone awry, according to Stuart Butler, director of domestic and economic policy studies at The Heritage Foundation, a Washington, D.C., conservative think-tank. Instead, Mr. Butler indicated that the American health care system, unlike its British and Canadian counterparts, was never actually planned, but rather evolved over time somewhat accidentally, which explains its current dilemma.

Individual Rights

Mr. Butler called on the right of the individual to freely choose a wellsuited plan, and not one that best suits an employer. As a successful working example of this proposal, he noted that federal employees are allowed to choose among 45 health care plans, regardless of their department.

Some of these packages advertise in the local newpapers to attract customers. He noted that union plans were especially popular, particularly during the 1980s when Reagan administration officials loathed organized labor's politics but enjoyed the benefits offered in their health care programs.

"What's good enough for the federal employees is good enough for all Americans," he added. "Let them have the same choice."

To support this proposal, the Heritage Foundation called for refundable tax credits for the purchase of health insurance and medical services, with a sliding scale tax system that would provide increased credits for higher costs.

Additionally, Mr. Butler asked for a mandate that would provide every American household with a basic package for catastrophic health care; government guarantees to cover the cost would pertain to applicable households and involve freedom to choose appropriate coverage to fit household needs.
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Title Annotation:ideas from Howard Dean, Governor of Vermont and Stuart Butler of The Heritage Foundation
Author:Hall, Phil
Publication:Risk Management
Date:Feb 1, 1992
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