HHS SECRETARY SHALALA: Cautious Steps Toward Reform
In a featured interview in today's Financial Times, Department of Health and Human Services Secretary Donna Shalala discusses the role of the Clinton administration in the evolving health care system. Shalala said that while the "days of the grand plan in health are gone ... the target of making progress in reforming a U.S. health system changing at the speed of light has not." She said, "Everyone thinks that we are moving towards government taking over health care. Not a chance. What we are trying to do is get the private and public sectors to work more closely together." Shalala defended the administration's recent efforts to expand health insurance coverage to children and the near-elderly. She called the widely attacked proposal to extend a Medicare buy-in option to the near-elderly "a very narrow, targeted program for a group of people for whom the private sector doesn't work. ... We are not substituting for the private market because there's no private market out there for that group of people." In terms of reforming the market, she emphasized that the administration would have to be "nimble and flexible and shrewder about where we intervene." She said among the priorities for the administration are "ensuring coverage for people between jobs, ensuring that those in their 20s who often drop coverage keep it, and reaching another five million children who remain outside the present program."
Learn To Adjust
Shalala acknowledged public discomfort over a perceived decline in health care quality under managed care. "The health insurers 'may have cut back a little too hard,'" she said, but noted that "[s]ome form of organized, managed care is here to stay." She suggested that some of the public's reaction may simply be a "'generational change' as Americas get used to a new way of receiving care." President Clinton's new "consumer bill of rights" is designed to address some of the quality issues, Shalala said. She added a warning to the industry that "if they chose to take us on, it's going to be us and the doctors and the public versus the industry: they're making a big mistake."
Purchasing PowerShalala points out the government's responsibility in using its enormous purchasing power to influence health care through economics, not policy. Together, Medicare and Medicaid, the Veterans Administration and other government programs "account for nearly half of all U.S. health spending." The government can choose to spend these programs' money on proven high-quality, cost-effective health care. "We are the biggest purchaser of health care in the world. So when we set our rules it affects everybody. We shape the private sector" (Timmins, 1/23.)This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.