Editor's Memo

A Highly Uncertain Future For 'Defined Contribution'

John Marcille

Every issue of this magazine is devoted to describing changes in the managed care industry. One of our goals is to find the trends before anyone else (especially the mainstream media) and offer information that may help you deal with these developments. We also like to offer "news you can use," the stuff that helps you get through your work day.

Our cover story disregards that template. Instead of telling you what will change, we're telling you what won't change. We're saying that a wholesale change to a defined-contribution system is nowhere near the horizon.

It's perhaps risky to take this stand when most health care periodicals, consultants, and e-health businesses say the opposite. We may appear somewhat less than savvy in our discounting of vouchers. Yet, it's fun to be contrarian — and to point out that it's in the financial interests of magazines, consultants, and, especially, e-health companies to talk up defined contributions. Moreover, if big business wanted such a change, the new administration in Washington would probably sign on.

Within the health care industry, we see some major barriers to defined contributions, such as the tax-structure and risk-sharing issues. Then, there are the employers who don't want to appear to be reducing benefits in a tight labor market.

This is certainly not to say that we're against change as a policy. It's just that you'd better be sure of the Platonic ideal before you disrupt everyone's coffee break.

Rodney G. Hood, M.D., the president of the National Medical Association and subject of our Q&A this month offers a strong argument for change when he says medicine is as biased as any other U.S. institution. Because physicians are trained to help people — regardless of race or any other factors — health officials are less likely to examine themselves for possible bias. As the facts and statistics Hood cites to bolster his position underscore, even unintentional bias can kill.

His call for change is one that should be heeded.

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