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Show basis for many of its recommendations. Some of the steering committee's recommendations regarding coverage for dependents up to age 26, continuity of coverage, and reform of the health insurance "anti-discrimination" laws, were included in HB 120 during the 1992 General Session and in HB 130 during the 1993 General Session. The task force focused on those steering committee recommendations that were easy to implement and were within the purview of the Legislature to accomplish. Other recommendations were made primarily to the private sector and to the executive branch of state government. Pursuing Economic Discipline in Utah-Report of the Blue Ribbon Committee on Health Care The Blue Ribbon Committee on Health Care was organized in the Summer of 1991 under the auspices and funding of Utahns for Non-Profit Hospitals. While the Health Care Steering Committee is composed mainly of providers, insurers, and government officials, the Blue Ribbon Committee is composed of some of Utah's leading business and civic leaders. Also, unlike the Steering Committee, which has no paid staff, the Blue Ribbon Committee retained the services of one of the country's leading health care consultants-Lawrence Lewin. Mr. Lewin has a history of working with the Utah health care system. Besides being a member of the Board of Trustees of Intermountain Health Care, he is the author of a legislative-commissioned report in the late 1970s which still constitutes the basis of the state's current policy of promoting competition to control health care costs. The Committee's report, "Pursuing Economic Discipline in Utah," was released in September 1992. The term "economic discipline" is frequently mentioned by Lewin as an alternative strategy to the use of strict regulatory measures or pure free markets to control health care costs. Speaking to the Access to Health Care Task Force, Lewin explained that "economic discipline means that you cannot pass on the cost of your actions to others with impunity" (Lewin, 1992, p.5). Lewin argues that in the health care system, economic discipline occurs when providers, patients, or insurers no longer transfer the economic consequences of their decisions onto someone else. The system would impose natural limitations, and each player would be accountable for the costs he or she incurs. The Blue Ribbon Committee developed its recommendations around four guiding principles. The first principle is to control the "access/cost spiral." This concept is based on the assumption that part of the increase in health care costs for persons with health insurance is attributed to their partial role in paying for the health care of persons without health insurance. Lack of access for those who are uninsured leads to higher health care costs because they are unable to pay. These higher health care costs are then passed on to those who do have insurance in the form of higher premiums. Higher premiums lead to even less access because as the premiums increase, fewer people are able to pay-hence the upward spiral. The Committee recognized that the insured business community must pay higher health insurance premiums for the health care of persons who are not insured. Additionally, the Committee believed that the Medicaid and Medicare programs do not pay their full costs. Consequently, those costs are "shifted" to self payers and private insurers. Cost shifting is further exacerbated by the fact that when the uninsured do enter the health care system, they often do so at its most inefficient and expensive points. Therefore, part of any strategy to control increases in health care costs must also focus on ways to improve access to health care for everyone (Blue Ribbon Committee on Health Care, 1992, p. 2). Second, the Committee believes that the private sector should find ways to make competitive markets more effective, and improve economic discipline. The Committee recommends that this be accomplished by helping the private sector purchase health care more effectively. One way to do this is to form employer coalitions that can "use their market clout 110 HEALTH CARE REFORM |