Getting the Haves to Come out Behind: Fixing the Distributive Injustices of American Health Care

Hyman criticizes an article by Havighurst and Richman regarding the distributive injustices of US health care. Hyman also offers a guide for implementing policy reforms based on the analysis by Havighurst and Richman

The Massachusetts Health Plan: The Good, the Bad, and the Ugly

In spring 2006, Massachusetts enacted legislation to ensure universal health insurance coverage to all residents. The legislation was a hybrid of ideas from across the political spectrum, promoted by a moderately conservative Republican governor with national political aspirations, and passed by a liberal Democratic state House and Senate. Groups from across the political spectrum supported the plan, from the Heritage Foundation on the right to Families USA on the left, although the plan had detractors from across the political spectrum as well. This study briefly describes the basic structure of the Massachusetts plan and identifies the good, the bad, and the ugly. Although the legislation, as Stuart Altman put it, "is not a typical Massachusetts -- Taxachusetts, oh -- just -- crazy -- liberal plan," there is enough "bad" and "ugly" in the mix to raise serious concerns, particularly when the desire to overregulate the health insurance market appears to be hard -- wired into Massachusetts policymakers' DNA. If we want to make health insurance more affordable and avoid the "bad" and the "ugly" of the Massachusetts plan, Congress -- or, barring that, individual states -- should consider a "regulatory federalism" approach. Under such an approach, insurers and insurance purchasers would be required to subject themselves to the laws and regulations of a single state but allowed to select the state. As with corporate charters, this system would allow employers and insurers to select the regulatory regime that most efficiently and cost -- effectively matches the needs of their risk pools. The ability of purchasers and insurers to exit from the state's regulatory oversight (taking their premium taxes with them) would temper opportunistic behavior by legislators and regulators, including the temptation to impose inefficient mandates and otherwise overregulate

Accountable Managed Care: Should We Be Careful What We Wish For?

Managed care is exceedingly unpopular of late. Many people believe that the problem is managed care organizations (MCOs) are unaccountable. Indeed, for many people, the creation of tort-based accountability for MCOs is the touchstone for assessing legislative reform. The case for tort-based accountability is actually quite complex, and the merits of tort-based accountability cannot be resolved with sound bites and bad anecdotes. Tort-based accountability has both costs and benefits, and little attention has been paid to the extent to which alternatives to tort-based accountability are found in existing institutional arrangements. This Article systematically considers the extent to which alternatives to the tort system have become widely accepted parts of the commercial landscape, and the trade-offs associated with the use of the tort system to deliver accountability. The Article concludes with ten suggestions for regulating managed care if the goal is actually to improve the care provided