ABSTRACT

This chapter discusses the kind of market health care reform proposals intend to create, looks at some of the practices in the private-employer based insurance market that undermine access, cost containment, and quality assurance and examines the several levels of federal or state government intervention proposed to restrain these practices. It describes the first three levels, or "market-improvement" proposals. The leading group of health care reform proposals before Congress argues that the way to bring about broader access to care and contain the costs and assure the quality of health care is to "improve the markets" for health insurance and health care in the country. The market reform approach to health care would accelerate the pace at which insurers and providers move toward these vertically integrated managed care arrangements in order to constrain year-to-year increases in health care costs. Reform proposals based on improving the health insurance market can be seen as falling into five levels of increasing government intervention.