Managed cooperation, not competition: a proposal for implementing national health reform.

SUMMARY National health reform should be implemented in a policy framework that encourages cooperation--not competition--to promote efficiency while extending universal coverage. "Managed cooperation" is defined here as a national health system built on collaborative efforts between purchasers, providers, consumers, and government through voluntary collective action, like the structural cooperation seen in the Japanese economy between government and the private sector. Six partnerships are encouraged: (1) government-industry, (2) purchaser-provider, (3) physician-hospital, (4) public-private data sharing, (5) consumer-provider, and (6) community health. Structural and legal barriers to cooperation, such as antitrust and malpractice reform, should be reduced or eliminated to encourage collaborative initiatives under national health reform. In 2010, good health for all is a national and global priority. Our social systems and institutions support an America and, more broadly, a world where each individual's well-being and full potential are minimally impeded by illness, disability, and environmental hazards. Individual behavior, organizational behavior, the management of societal and environmental hazards, and the provision of health care combine to create a healthier society. --The Belmont Vision (Sasenick 1993) What America needs is a new model of managed cooperation--not competition-to achieve the goals of national health reform. With a cooperation strategy, the United States could restructure its health system for the twenty-first century and speed the transformation of American health care delivery. National health reform is an opportunity to fundamentally restructure the American health system, yet to retain its voluntary, pluralistic nature. The danger of health reform is that the Washington policymakers could "throw sand in the gears" with heavy-handed pricing controls (Faltermayer 1993). Managed cooperation can be defined as a national health system built on collaborative efforts between purchasers and providers and consumers and government that makes universal access to health care available and contains costs through voluntary collective action at the national, state, and local levels. The rationale for cooperation is compelling. * Employer cooperation in enrolling uninsured workers would create stable multiemployer purchasing cooperatives without adverse selection and risk, as well as a level playing field for all business firms. * Provider cooperation with reforms would reduce potential overtreatment and exploitation of the $50-100 billion of new funding to insure the 37 million uninsured. * Health care worker cooperation through empowerment and "no-boss" organizations would boost productivity, lead to discovery of practical cost-efficiencies, and enhance customer satisfaction. * Insurer cooperation in developing a universal electronic claims network would reduce administrative expense. Purchaser-provider cooperation under risk-sharing agreements and capitation would further reduce the estimated 15-25 percent administrative burden of the current system. * Supplier cooperation in mitigating price increases would minimize the need for mandatory price controls. * Consumer cooperation in compliance and managing a healthier lifestyle would reduce high-cost acute "medical accidents" such as heart attacks and strokes. * Medical education cooperation to produce more primary care physicians and multiskilled health care professionals would meet the increased need for routine care that national access reforms will create. * Government cooperation between the executive, legislative, and judicial branches would break the gridlock on funding health access, expanding support for badly needed public health and wellness programs, reforming the malpractice system, offering antitrust relief for regional provider networks, and reducing government regulation. …