Lapham, John S.

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Washington University St. Louis: Open Scholarship

Urban Law Annual ; Journal of Urban and Contemporary LawVolume 46 A Symposium on Health Care Reform—Perspectives in the 1990sJanuary 1994A Symposium on Health CareReform—Perspectives in the 1990s: IntroductionJohn S. LaphamFollow this and additional works at: https://openscholarship.wustl.edu/law_urbanlawPart of the Law CommonsThis Introduction is brought to you for free and open access by the Law School at Washington University Open Scholarship. It has been accepted forinclusion in Urban Law Annual ; Journal of Urban and Contemporary Law by an authorized administrator of Washington University Open Scholarship.For more information, please contact digital@wumail.wustl.edu.Recommended CitationJohn S. Lapham, A Symposium on Health Care Reform—Perspectives in the 1990s: Introduction, 46 Wash. U. J. Urb. & Contemp. L. 1(1994)Available at: https://openscholarship.wustl.edu/law_urbanlaw/vol46/iss1/2A SYMPOSIUM ON HEALTH CAREREFORM-PERSPECTIVES IN THE 1990sINTRODUCTIONHealth care reform is arguably the most controversial issuefacing Congress in 1994. The structure of one-seventh of theAmerican economy is confronted with the most sweeping changesince the introduction of Medicare and Medicaid in 1965. Thestakes are enormous, the political interests diverse. This Sym-posium explores many of the issues involved.The Clinton Administration is at the forefront of the reformeffort. The President introduced the Health Security Act intoCongress after months of preparation by the health care taskforce headed by First Lady Hillary Rodham Clinton. The pri-mary feature of the Clinton Plan is universal coverage - allAmericans would have affordable health insurance. In an ad-dress before the faculty and student body of Washington Uni-versity in March 1994, the First Lady noted that the UnitedStates is the only major industrialized nation that does notprovide health care for its citizens. Adoption of the ClintonPlan, she asserted, will move the United States toward "becom-ing the nation we should be."Economist Gail R. Wilensky, Health Care Financing Admin-istrator under the Bush Administration, spoke at WashingtonUniversity School of Law in April 1994. Dr. Wilensky arguesthat the Clinton Plan is financially suspect and, given themembership of the 103rd Congress, politically untenable. Heranalysis appears in Health Care Reform: Is 1994 the Year?The Jackson Hole Group, the influential health care policythink tank, provided the original theoretical framework for theClinton Plan. The Group's analysts stress the potential of amanaged competition model. Their most recent version of themodel, updated to reflect empirical experience, is contained inManaged Competition II: A Proposal.A major controversial component of the Clinton Plan is theemployer mandate, which would require all employers to payfor a part of their employees' health insurance. Small businessemployers are, not surprisingly, opposed to this increased costof doing business. More curious is the negative response of largeWashington University Open Scholarship2 JOURNAL OF URBAN AND CONTEMPORARY LAWcorporate employers, most of whom already provide health carebenefits. Some of the reasons for the overwhelming corporateopposition to the Clinton Plan are described by Herschel V.Sellers III in Health Care Market Reform: A Corporate Em-ployer's Perspective.Changing the United States' health care delivery system doesnot require diving into completely uncharted waters. The healthcare systems of other industrialized nations offer multiple casestudies of what does and does not work. Leo van der Reis,M.D., Director of the Quincy Foundation for Medical ResearchCharitable Trust, looks at various foreign programs and dis-cusses the implications for the United States in Health Care inAmerica: In Perspective, In Reality.Some form of health care reform appears inevitable, but isgovernment-provided health care truly appropriate? ProfessorRoberta M. Berry argues that the principles of welfare conse-quentialism, or "welfarism," do not readily apply to the healthcare context because welfarism cannot "accommodate diverseand highly valued preferences regarding the delivery of individualhealth services." The very foundation of health care policyanalysis is thus theoretically flawed, as illustrated in NationalHealth Care Reform: Welfarism Out of Context.The financing of universal health care may be the overridingconcern blocking reform legislation. Paul J. Donahue analyzesthe tax structure currently employed to finance health caredelivery, the theoretically appropriate tax structure, a politicallyexpedient tax structure, and the Clinton Plan, Mr. Donahuepresents a tax proposal that is both theoretically appropriateand politically attainable in Federal Tax Treatment of HealthCare Expenditures: Is it Part of the Health Care Problem?Many of these issues may soon become moot if Congresspasses health care legislation in 1994. However, we anticipatethat the discussion will not automatically cease nor will theproblems be instantly solved; they will all be revisited in thenear and distant future. This Symposium, in addition to aidingthe current debate, is also intended to chronicle the issues ofthe day for tomorrow's generation of legal scholars. The editorswish to thank each of the contributors herein, and hope thatour readers will learn as much as we have on the multifacetedissues within health care reform.John S. LaphamExecutive Articles Editor[Vol. 46:1https://openscholarship.wustl.edu/law_urbanlaw/vol46/iss1/2

A Symposium on Health Care Reform—Perspectives in the 1990s: Introduction

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A Symposium on Health Care Reform—Perspectives in the 1990s: Introduction

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