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Show exactly what health care for which we wish to provide access. The amount of health care that a society can consume is theoretically infinite. No society can afford to provide all the health care that all of its citizens may potentially desire (Priester, 1992, p. 92). Each society needs to define the level of health care to which everyone is entitled. Only then can it balance what it spends on health care with all of its other demands, such as roads, housing, and education. Second, what should public policy say about the rational basis for private health insurance? Traditionally, we have viewed insurance as a system where we indemnify ourselves from losses by the many paying for the few. Risk is spread or "socialized" across a large and diverse population. However, this traditional approach does not generally apply to today's health insurance market. Risk spreading has been replaced by risk avoidance and risk segmentation. Market forces and evolving state and federal laws have forced the insurance market to avoid insuring the sick. Society has also contributed to this change by our lack of willingness to explicitly shoulder each other's health care expenses. In addition, many health insurance plans now pay for routine and expected expenses as well as unexpected expenses. Segmenting risk and paying for predictable expenses are two features of our current health insurance system that have not been associated with traditional insurance concepts. Are these assumptions about insurance still valid? Or, do we need to redefine the philosophy so that it more closely matches reality? Third, to what extent do we wish to maintain the linkage between how much health care a person gets and where they are employed? Employers initially offered health insurance benefits to induce workers into the workplace during labor shortages. The system has now evolved and expanded in part because of the favorable tax treatment of employer-provided benefits, and because they are now included in many collective bargaining arrangements. Some nations have abandoned the linkage between employment and health insurance. Other countries have built their health care systems around employer-provided insurance. Some states have also attempted to expand the availability of health insurance by requiring employers to provide health insurance. Finally, should health care cost containment strategies focus on demand, supply, or both? Health care expenditures are a function of the volume of services consumed, the price of those services, and the efficiency (amount of input per unit produced) at which those services are delivered. Health care cost containment strategies can focus on limiting prices, controlling volume, or improving efficiency. The answer to this question is partly answered by the extent to which society wishes the public sector to intervene in the health care system in order to control costs. What The Plans Say Access to What-All proposals reviewed above recognize the need to define a level of "basic" or "essential" care, but for different reasons. Under SB 153, a basic benefit plan is a required part of the bill's guaranteed issue provision. The Blue Ribbon Committee and the Steering Committee both call for the adoption of some type of basic benefit plan, but only to improve price competition in the marketplace. Both committees argue that the lack of a standard health insurance product makes price comparisons impossible. A uniform basic benefit package, defined and priced, would encourage more price competition. Finally, SB 195 and HB 64 also require the establishment of a basic benefit package, but as part of an overall scheme to provide universal health insurance. Rational Basis for Insurance-With regard to refining the philosophical basis for insurance, the consensus from the reports and legislation is clear-we should promote the socialization of risk and move the health insurance market back to what we traditionally view as being the purpose of insurance. HB 130, SB 153, SB 195, and HB 120 all attempted to reform the small group health insurance market to 112 HEALTH CARE REFORM |
