A Cautionary Note on Market Reforms in Health Care

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Abstract
IN DECIDING not to act on the Clinton health reform proposals in September 1994, Congress voted against an enlarged role for the federal government in health care. But that action did not suggest, much less confirm, its satisfaction with the status quo or its indifference to rapidly rising health care expenditures, growing numbers of the uninsured, and the presence of considerable waste and fraud. In the ensuing months the American public has been informed by a growing number of interested parties that "the market" will achieve many, if not all, of the reforms that President Clinton had earlier identified as health system priorities. Economists have always favored reliance on the market to achieve productivity gains, a predilection that is shared by the new Republican majority and by the corporate executives of managed care companies, old and new, that ascribe their growing profitability to the virtues of the market. In short,

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