Insurance mandates are another important consideration in connection with proposed healthcare reforms. Tumulty references the Clinton administration's failure to achieve universal healthcare coverage largely because of the insurance mandate issue. The principal fear is that employer mandates would trigger the collapse of many small businesses (in particular), as well as increase the national unemployment rate. On balance, it would seem that the opposition has failed to explain exactly why individual healthcare insurance mandates could not be implemented by state law, especially with appropriate waivers based on insufficient income.
The fourth dilemma outlined by Tumulty relates to the difficulty of defining health care coverage and criteria within the universal coverage concept. Admittedly, doing so requires complex analyses and decisions, but that may very well be preferable than the current situation. Specifically, today, equally complex analyses and decisions are left to the private insurers who have a profit motive and an obvious conflict of interest.
Finally, Tumulty addresses the need to reduce the cost of modern medicine. The author correctly points out the importance of reducing the funds and other resources wasted under the current healthcare delivery model. She also accurately states the fact that the fee-for-service model used in the U.S. is tremendously inefficient and wasteful. Regardless of the resolution of other important...
Furthermore, effective healthcare reform must perfect record-keeping functions and information-sharing protocols to ensure that tests and treatments are not duplicated unnecessarily and at great financial cost. Finally, Tumulty correctly mentions the importance of a greater emphasis on comparative-effectiveness research to identify the most effective and cost-effective therapeutic approaches. Ultimately, the fifth dilemma addressed by Tumulty is the best presented. The other four analyses outline the basic concerns but seem to have left out fundamentally important factors, mainly in relation to the amount of costs savings and expanded care that depend on restricting the role of private insurers. As long as that issue is resolved, it matters much less whether it is achieved through competition in the form of a public option or by tighter regulations such as profit maximums and reduced authority over coverage decisions.
According to Karen Tumulty's article, successful U.S. healthcare reform may depend substantially on five major issues that she characterizes as
