The Health-Care System Needs Strong Medicine

摘要

Corporate benefits managers are reeling from the latest premium hikes, even as the number of uninsured Americans sets a new record. In the 2004 Presidential campaign, George W. Bush and John Kerry, in very different ways, will try to square a policy circle-attempting to simultaneously expand coverage and contain costs. For President Bush, market incentives serve both goals. Bush's recently enacted Medicare revision, for instance, offers new drug benefits, but with extensive out-of-pocket payments. This strategy limits government's cost and, presumably, creates incentives against overuse of expensive medicines. The Administration also relies on voluntary discounts by the pharmaceutical industry. It not only rejects price controls but explicitly prohibits Medicare from negotiating volume drug discounts. The law also creates incentives to encourage seniors to switch from conventional Medicare to managed-care plans, on the premise that competition will increase efficiency. It dramatically expands tax-advantaged medical savings accounts. President Bush proposes additional tax credits to subsidize the purchase of individual or small-group policies.