Is universal health coverage possible? - Alain Enthoven's consumer choice proposal - Special Report - The 1990s: What's Ahead for Health Benefits - illustration

Business & Health, Dec, 1989 by Karen Hunt

"The key foundation of our proposal is to say, `Don't offer us an extra $1,000. Offer that to those who don't get a subsidy now."

Labor opposed

Enthoven's proposal is gaining ground with some key legislators on Capitol Hill including Sen. David Durenberger (R-Minn.) and Rep. Willis Gradison (R-Ohio). But the idea has some formidable opponents, including organized labor.

"The big problem is politically, of course, organized labor has dug in on opposing limits on tax-free employer contributions. It's unfortunate because a limit would not throw them for any kind of major loss.

"Whether we have universal health insurance or not, large group purchasers," he concludes, "have to get a lot smarter, more active, and better informed. They must consciously manage the process of competition in such a way as to reward the production of high quality, cost effective services. We have to stop rewarding skimming the risks, segmenting the market, differentiating the product, and other time-honored techniques to defeat competition.

"We need an active force on the demand side. There's no satisfactory substitute for an efficient, well-organized delivery system. The only way you can get that is to have most of the purchasers really seeking value for their money and being willing to make hard choices to get it."