Good intentions seldom result in good legislation, as Tennessee's effort to place Medicaid recipients in a managed-care program illustrates.
The TennCare program has been marred by hasty planning, insufficient payments to providers and inadequate government oversight. Applications for coverage in the first three months ran about eight times the number planners anticipated.
This disastrous effort provides a model for what happens when governments rush into healthcare reform. Major constituencies, such as the medical-care providers, were left out of much of the planning process in Gov. Ned McWherter's push to get a new Medicaid system in place.
Numerous states are struggling to implement reform proposals. Minnesota has delayed until next year a decision on how to pay for its universal coverage, scheduled to go into effect July 1, 1997. Florida faces a special legislative session this spring to resolve the question of funding its reform plan.
Lawmakers working to reform healthcare at the state and federal levels would do well to look to Oregon, where leaders took the time to consult representatives of all constituencies before deciding on a final course of action for its reform program, which is built around rationing.