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The Yin and Yang of Health Care System ReformProfessional and Political Strategies for Setting Limits
Norman Daniels, PhD;
James E. Sabin, MD
Arch Fam Med. 1995;4(1):67-71.
Abstract
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President Clinton's proposed Health Security Act1 would establish a National Health Board (NHB) with three key functions. The NHB would (1) decide which services are "medically necessary or appropriate" (Title I, Subtitle B, Section 1154), (2) "recommend... appropriate revisions (to the benefit package)... to reflect changes in technology, health care needs, health care costs, and methods of service delivery" (Title I, Subtitle F, Section 1503, [a] [2]), and (3) "determine a national per capita baseline premium target" (Title VI, Subtitle A, Section 6002, [al]), thereby establishing a national health care budget. To date, including the work of Mrs Clinton's Task Force on Health Care System Reform, there has been little discussion of how the NHB would carry out these responsibilities. Critics claim that a budget cap would require rationing. Advocates counter that eliminating waste would make rationing unnecessary. In the imagined "testimony" that follows, we recommend two strategies to the NHB for carrying out its three key functions and for addressing the controversy about whether it should consider rationing.
Author Affiliations
From the Departments of Philosophy and Community Medicine, Tufts University, Medford (Dr Daniels), and Harvard Community Health Plan and the Department of Psychiatry, Harvard Medical School, Boston (Dr Sabin), Mass.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Making Insurance Coverage for New Technologies Reasonable and Accountable
Sabin and Daniels
JAMA 1998;279:703-704.
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