ABSTRACT
This chapter examines the issues involved in implementing a basic benefit plan using clinical guidelines as lines suggested in the Model Proposal. The Model Proposal envisions that a panel will use scientific evidence to determine whether various medical procedures have been shown, under a specific burden of proof, to provide an expressed level of benefit. The chapter argues that the substantive core of the Model Proposal can be made to work: that one could create scientifically valid clinical guidelines that would provide both significant cost savings and improved quality. It is concerned with the legal and political issues which would affect implementation of the Model Proposal, or of another proposal relevantly like it. The chapter discusses three legal and political attributes essential to the successful functioning of such a proposal: legitimacy, legality, and integrity. It also discusses an institutional structure that might both yield a successful system and help get such a system adopted.
