US Health Reform And The 104th Congress

Health system reform in the USA is needed now more than ever, but the political climate facing the 104th Congress means any change will be in a much different form than was originally proposed by the Clinton administration, according to articles in the Journal of the American Medical Association.

"The lessons learned from this (1994) year are clear," according to John Seward, chairman of the AMA board of trustees and James Todd, executive vice president of the AMA. "Any proposals realistically to be considered must be simple and easily understood," they comment, and "they must have fairly general appeal to the public and legislators. They must have a minimum of government interference and bureaucracy. They should place people - not profit - at the center of attention. Above all, they should be in politically-acceptable bite-size form."

Drs Seward and Todd suggest the 104th Congress should, at a bare minimum, consider a list of eight reforms. They say: - insurance reform is imperative; - "if competition is to be the engine of the delivery system, patients will need protection from unscrupulous entities more interested in healthy profits than healthy people;" - "if physicians are expected to make more rational the care they give, relief from professional liability must occur;" - "if the public expects professional standards to be upheld and physician expertise utilized, there must be protection from antitrust persecution if the physicians are to preserve their voice in matters medical;" - "quality of care and value for the dollar spent must be documented;" - "reduction in the escalation of health care expenditures must occur through emphasis on primary and preventive care of full immunization, prenatal care and encouragement of healthier lifestyles as well as innovative reimbursement measures, and patient participation in the economic consequences of their health care decisions;" - "access to appropriate specialty care must be preserved, especially for those patient groups whose diseases require ongoing specialized management skills;" and - "freedom of choice both for patients and physicians in the manner they choose to receive and deliver care must be preserved, albeit perhaps with different price tags." They write: "we have passed through a year of conflict, and it is now time to begin the process of consensus building."