The yin and yang of health care system reform. Professional and political strategies for setting limits

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Abstract
President Clinton's proposed Health Security Act would establish a National Health Board (NHB) with three key functions. The NHB would (1) decide which services are "medically necessary or appropriate" (Title I, Subtitle B, Section 1154), (2) "recommend ... appropriate revisions (to the benefit package) ... to reflect changes in technology, health care needs, health care costs, and methods of service delivery" (Title I, Subtitle F, Section 1503, [a] [2]), and (3) "determine a national per capita baseline premium target" (Title VI, Subtitle A, Section 6002, [a]), thereby establishing a national health care budget. To date, including the work of Mrs Clinton's Task Force on Health Care System Reform, there has been little discussion of how the NHB would carry out these responsibilities. Critics claim that a budget cap would require rationing. Advocates counter that eliminating waste would make rationing unnecessary. In the imagined "testimony" that follows, we recommend two strategies to the NHB for carrying out its three key functions and for addressing the controversy about whether it should consider rationing.

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