The Health Care Solution: Understanding the Crisis and the Cure

The authors offer the hospital's point of view regarding the Clintons' proposed solution to America's health care situation

Writing with Bowker ( The Visionary Leader ), Dauner, CEO of the California Association of Hospitals, here offers his proposals for restructuring health care. Comparing the plans of other nations, and citing reasons for the soaring medical costs, Dauner proposes limiting government to a policy and support role. His plan of "managed collaboration" calls for universal access to a unified benefit package stressing prevention and funded by full capitalization from individuals and large and small business alliances at rates to be negotiated between carriers and health networks. Networks are to be chosen by consumers, with general practitioners acting as "gatekeepers" for patients. Unlike the Clinton plan, Dauner prefers a "bottom-up" approach to a "formula-driven, top-down" payment cap. Among the spate of recent books on the subject, this one stands out. 15,000 first printing; $25,000 ad/promo; author tour.
Copyright 1994 Reed Business Information, Inc.

Another precinct is heard from in the health care reform debate: this time, hospitals. Dauner has headed the California Association of Hospitals and Health Systems since 1985; his collaborator is a widely published freelance writer. For Dauner, the federal government's "well-intentioned acts," most significantly, enactment of Medicare and Medicaid, caused the current "crisis." For this reason, and because "the hearts and minds of the American public would be lost in a federally orchestrated prescribed command-and-control approach," Dauner's "solution" is another version of market-oriented tinkering with the current system's messed-up incentives. "Managed collaboration," Dauner's variant on the Clintons' "managed competition," restricts the federal government to "a policy and supportive role," calls for vertically integrated community health plans (CHPs) and capitation or bundled payments to providers, and gives health-care providers more power and insurers less power in structuring and directing the CHPs, which would supply medical services to health-care alliances, larger employers, and the government itself. There are few surprises here, but Dauner presents the hospitals' concerns effectively. Mary Carroll