[Skip to Content]
[Skip to Content Landing]
January 27, 1993

Unspecified Reform Tops Agenda

JAMA. 1993;269(4):447. doi:10.1001/jama.1993.03500040009003

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.


THOSE WHO SAY managed competition is the wave of the future like to count newly inaugurated President Bill Clinton as one of their own.

However, the new President, while repeatedly saying that health care reform is at the top of his agenda, has made no commitments on how to do it.

Clinton has said he leans toward a market-based approach like managed competition. This new buzzword describes proposals in which health insurance purchasing cooperatives would broker and referee insurance coverage, with the goal of giving everyone the benefit of large-group rates while trying to promote competition among networks of health care providers.

These purchasing cooperatives in theory would promote improved quality and lowered costs by rewarding those insurance plans with the best quality and lowest costs with more subscribers (JAMA. 1991;265:2532-2536). Most versions of such a plan also call for taxing health insurance benefits that go beyond a "basic" level