Reforming Private Health Insurance.

Reforming Private Health Insurance. – book reviews

J. Douglas Knoop

The failure of the Clinton initiatives at reform of our health care system last year and the election of a Republican Party-dominated Congress may, at first glance, make it seem that further efforts at health care reform are unlikely. In fact, President Clinton’s State of the Union address indicated he wishes to proceed, although along narrower paths. In addition, Speaker of the House Newt Gingrich and Senate Majority Leader Bob Dole have begun speaking of their own d6signs for possible areas of reform.

By most accounts, such efforts at “reform” will be quite limited in scope, at least compared to last year’s massive and varied proposals. However, discussions concerning attempts to “reform” the health insurance industry are widespread. This may include small market reform, preexisting condition changes, portability, etc. An excellent resource for understanding the policy, politics, and especially the economics of the private health insurance market is found in this book.

The book works from the premise that we are always going to rely on private financing of health care. From that point, Professor Hall, a professor of law and public health at Wake Forest University School of Law and the Bowman Gray School of Medicine and an associate in management at the Babcock School of Management, gives a very lucid account of why we have insurance; why it has “disintegrated” in terms of society’s needs; and, perhaps most important, what social function health insurance serves. From there, the remainder of the book comprises two short but lucid chapters covering insurance market reform under both voluntary and mandatory systems of purchase.

In the discussion of voluntary systems of purchase, Professor Hall addresses various reform proposals (some aspects of which are somewhat dated at this stage of the health reform debate) and the effects of reform on the small group market. In the section on mandatory purchase, he gives brief and incisive accounts of community rating and purchasing cooperatives. His descriptions of rating bands, adverse selection, risk adjustment, reinsurance issues, and many other aspects of the insurance market are cogent and pertinent.

This book will be very useful to any physician executive who deals with such issues either from a clinical aspect or from the managerial/administrative side of health care. It will also be useful to those who merely want a better understanding of these matters. It is a very compact, understandable analysis and explanation of a complex topic. Anyone who desires a quick, yet thorough overview of this subject, which is sure to become more intensely debated, could profitably spend a few hours with this work. – J. Douglas Knoop, MD, Section Head, Otolaryngology, Lexington Clinic, Lexington, Ky.

COPYRIGHT 1995 American College of Physician Executives

COPYRIGHT 2004 Gale Group