If the federal government wasn't prone to changing the rules, perhaps small businesses could live with a mandate to pay at least half the cost of employee health insurance. It's the key to achieving reform. Such a mandate would help the Clinton administration reach its goal of widening access to the system for millions of uninsured Americans and building a framework for lower costs.
The 50-50 arrangement would be a legal minimum, but benevolent or successful employers could raise their share above the halfway mark. A health insurance partnership between employees and employers also would provide a powerful weapon against runaway healthcare inflation and ensure provider accountability. Combined with community rating, portability and risk sharing, payers at least would gain more stability and predictability in the health insurance system.
To build volume, providers would respond with risk-sharing agreements, outcome measures, wellness programs and patient-satisfaction programs. Patients, who would be paying more out-of-pocket costs for coverage, might ask more questions and demand more answers from physicians and hospitals.
In a sense, competition in healthcare would be heightened in response to reform. More importantly, the trend toward capitation and risk sharing should add rationality to the present system, which is fraught with perverse incentives to overtreat illness and injury.
About 85% of Americans now have health insurance. Most people who lack coverage live in households with at least one worker. There is a health insurance problem, not a healthcare crisis. After months of haggling, Democratic leaders in Congress were right in telling President Clinton and the first lady to back off. Their approach was simply too much, too fast and too costly.
By crafting a more deliberate, less extensive program, Congress can get the nation on the right reform track. Any bill that passes Congress is likely to contain triggers, guidelines and goals stretching into the 21st century.
Getting employers to buy into a reform bill will require a hard and fast promise that the 50% mandate won't increase. Such a guarantee, if it is not tinkered with, also would help restore confidence and trust in the federal government.