Incremental Health Care Reform

Abstract

FOR THE 15 YEARS SINCE THE LAST EFFORTS AT MAJOR federal health reform receded, advocates have waited for the right moment to push again. That time appears be now, as the Obama administration seems committed to health reform. Further, consensus seems to be emerging among health reform advocates on the structure of reform beyond extension of the State Children’s Health Insurance Program (SCHIP). Momentum is gathering around the combination of 2 reforms: making Medicare available to all citizens and strengthening public oversight of the small-group and individual insurance markets through a Massachusetts-style “connector.” The 2 together would create more substantial governmental oversight and control of health care than ever before, but this would occur in what appears to be an incremental fashion and market competition could ostensibly be preserved. As a result, the proposal may be more politically palatable than previous reform efforts. In this Commentary, we review this approach and the factors that give it political momentum.