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ASU expert weighs in on health care reform


September 10, 2008

Fear and hope surround the controversial issue of health care reform in America. While the presidential candidates are announcing their plans to deal with reform, one expert is endorsing some politically viable recommendations, stopping short of universal health care.

“All countries wrestle with the same issues about what they want to attain with their health care systems,” said Marjorie Baldwin, director of the School of Health Management and Policy at Arizona State University’s W. P. Carey School of Business and author of more than 30 health care articles. “You are constantly trying to deal with three different major needs: providing everyone with access to health care, making it high quality care, and efficiently delivering it at a low cost. The catch is, you can really only do two of these things at any time.”

In other words, if you provide low-cost health care to everyone, then the quality may suffer. If you provide high-quality care to everyone, then the price will go up. If you deliver high-quality care at a low cost, then you won’t be able to provide the care to meet everyone’s needs, or wait times and access will be problematic. That’s demonstrated in countries with universal health care, such as Great Britain, where patients can wait months for routine treatment.

Baldwin, a top health economist, has noted disparities in health care across states, providers, and racial and ethnic groups. She also says the wrong incentives are being given to patients and providers. She agrees with many other economists in her sector regarding several recommendations considered more politically acceptable than universal coverage to address current problems in the health care system. For example:

• Equalize tax treatment for buying health insurance, so people can purchase coverage through their employer or on their own with the same tax break.

• Nationalize the health insurance markets, so there is less inequality across state lines, and consumers can have more choices about the plans they purchase. Right now, different states require different types of plans.

• Offer lower premiums to those who live healthy lifestyles.

• Offer more high-deductible policies, so people will be more selective about whether they really need to see a doctor. However, discounts could be offered to ensure that people still get preventive services.

“Most of this is just common sense,” said Baldwin. “I get reductions in my homeowners insurance because I have a security alarm and smoke alarms. I pay less for car insurance when I have no accidents. It just makes sense that you should pay less for health insurance, if you live a healthy lifestyle and get preventive services like mammograms and other screenings.”

No matter what, some people are risk takers who will choose to go without insurance, unless there is a mandate or universal coverage. About 5 percent of those who could purchase health insurance through their employers choose not to do it, even if they don’t have another option through a spouse.

Regardless, no country has the perfect health care system. Baldwin points to surveys that show about 70 percent of people in other countries believe their health care systems need major changes or a total overhaul. That’s similar to the percentage of those in America who are dissatisfied with the U.S. health care system.

Baldwin recently spoke about health care reform at the 2008 National Association of Women Business Owners annual conference in Phoenix. For more information on the speech, go to the Knowledge@ W. P. Carey Web site at http://knowledge.wpcarey.asu.edu/article.cfm?articleid=1632. For more on what the candidates should be saying on health care reform, go to the School of Health Management and Policy’s Web site to order a policy brief called “What the Candidates Should Be Saying About Health Reform” by Dr. Mark Pauly.

The School of Health Management and Policy at the W. P. Carey School of Business offers graduate programs to prepare students for managerial positions in health organizations. The faculty does cutting-edge research on health policy, health care delivery and health information systems.