Free Market or Mandate? (Whom Do You Trust?)

So much happens at each National Managed Health Care Congress that it is impossible to distill the experience. Thousands of physicians, pharmacists and other professionals, plus hundreds of vendors, converged on Atlanta last month. Still, some things stand out.

At the the policy level, there was concern for structural and political issues, the former exemplified by Harvard Professor Regina Herzlinger’s keynote talk on market-driven health care. As it happens, Senior Contributing Editor Patrick Mullen interviewed her just a week before the conference, and you can read the transcript, starting on page 40.

Former New York Gov. Mario Cuomo, a Democrat, in a debate with a potential GOP presidential candidate, former U.S. Rep. Jack Kemp, also of New York, warned against trusting entrepreneurs to structure a health care system that will ensure availability of care for the growing ranks of the uninsured, though he did argue, “If you can do it privately, that’s the first choice.” Kemp spoke for tax credits or vouchers for the unemployed uninsured and tax deductions for the employed uninsured (Cuomo: deductions are wrong because they favor the wealthy).”There should be a direct subsidy to the poor,” Kemp said, observing, “Even my party has gone to extremes” in addressing the problem. Notably, they agreed that definitive action on this issue and most of the many managed care regulations proposed in Washington is unlikely this year.

So much for policy. At the nitty-gritty level, there was a lot of attention to legal liability–providers have it; health plans may have to confront it–as well as disease management successes (finally being documented) and the newer kinds of managed care organizations, such as provider-sponsored organizations and integrated systems. The ideas batted around, no less than the web of contacts and alliances made by the thousands of participants, will surely affect the development of health care.

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