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An Outline Proposal For Health Care Reform

I started this blog by announcing I knew how to reform the health-care system; it seems appropriate, then, that I actually include my health-care reform proposal for people to evaluate. This plan has gone through several revisions; the version included here is the one sent to Governor Dean of Vermont.

The plan is an outline. Many of the provisions may seem individually unpalatable and only become acceptable (if ever) as one piece of an integrated whole, with checks and balances from other provisions to reign-in their more unsavory characteristics. For that reason, please read through to the end rather than stopping as soon as you come to something with which you are uncomfortable. The plan is not ideal; it is merely as practical as I can envision.

Further, although I proposed this plan and encourage its use on the assumption that we will, at some point, end up with some kind of health care reform that revolves around government — and that the alternatives are infinitely worse — I am not myself completely comfortable with what I’ve proposed. Please read my original cover letters to the Concord Coalition and to Governor Dean for the constraints I feel we are under.

27 February 1997

An analysis of the health-care reform agenda

At its center, the health-care reform movement wishes to achieve three goals:

  1. Fair and equitable distribution of health-care resources
  2. Highest possible quality of health-care practice and technology
  3. Economically efficient delivery of health-care services

In general, different factions in the debate each tend to emphasize a single goal, dismissing the others as of secondary (or minimal) importance. It is, however, not possible to separate the issues so cleanly. The moral desirability of a fair and equitable health-care system is universally accepted but for moral, political, and selfish reasons the public will not (and should not) tolerate significant quality deterioration in pursuit of that fairness. Similarly, the practical desirability for an efficient health-care system is driven by the need to ensure resources are available to achieve both fairness and quality; sacrificing either to achieve that efficiency is self-defeating, while sacrificing efficiency to achieve one will merely ensure the resources aren’t available to achieve the other. Thus, any reasonable reform plan must include elements to address all three goals.

While these goals are interdependent, they are not necessarily complementary. The first goal is sociological in nature, while the other two are economic. Any two of these goals may be at odds with each other and any mechanism which optimizes one may make the others worse. This is the dilemma which any reasonable reform plan must overcome.

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