The yin and yang of health care system reform. Professional and political strategies for setting limits
N. Daniels and J. E. Sabin
Department of Philosophy, Tufts University, Medford.
President Clinton's proposed Health Security Act would establish a National
Health Board (NHB) with three key functions. The NHB would (1) decide which
services are "medically necessary or appropriate" (Title I, Subtitle B,
Section 1154), (2) "recommend ... appropriate revisions (to the benefit
package) ... to reflect changes in technology, health care needs, health
care costs, and methods of service delivery" (Title I, Subtitle F, Section
1503, [a] [2]), and (3) "determine a national per capita baseline premium
target" (Title VI, Subtitle A, Section 6002, [a]), thereby establishing a
national health care budget. To date, including the work of Mrs Clinton's
Task Force on Health Care System Reform, there has been little discussion
of how the NHB would carry out these responsibilities. Critics claim that a
budget cap would require rationing. Advocates counter that eliminating
waste would make rationing unnecessary. In the imagined "testimony" that
follows, we recommend two strategies to the NHB for carrying out its three
key functions and for addressing the controversy about whether it should
consider rationing.
