Health care reform choices explored in publication.

In the wake of the Clinton Administration's failed health care reform effort, it is easy to become preoccupied with the political errors that killed reform last year. But the realities behind that debate still exist: growing millions of Americans who do not have health insurance and the need for

A new book argues that these challenges must be confronted, and outlines the choices that exist for reforming the U.S. health care system. Can any partial measures do much good without the full-fledged reform that proved so frightening? What kind of comprehensive health care reform would be best for the United States? Do the experiences of other countries offer lessons for what our next steps should be?

In Competing Solutions. American Health Care Proposals, Brookings Senior Fellow Joseph White offers the serious observer of health care policy a thorough analysis of the American health care system and those of six other industrialized countries - Australia, Canada, France, Germany, Japan, and the United Kingdom. Those countries' arrangements differ from each other in many details, but all follow a common general approach that ensures all their citizens are able to obtain necessary health care.

In the second half of the book, White reviews the theory of managed competition and its role in the 1993-94 debacle. He shows why plans that relied on managed competition alone were doomed to fail. Yet the Clinton Administration's plan, which sought to combine managed competition with the lessons of foreign experience, was also fatally flawed. In his conclusion, White suggests a way to combine these competing solutions in a system uniquely adapted to the United States.

Four choices now remain for the United States, White says: do nothing; take small, incremental steps toward reform; free States to attempt their own reforms; or move toward a uniquely American version of universal coverage.

White argues that the status quo - having the highest costs in the world with the greatest access problems among advanced nations - is unacceptable. In the other countries, everybody is guaranteed decent standard coverage and a few - the wealthy - may buy more. Only in the United States do the inequalities exist at the bottom: Most people have fairly decent coverage, but a large chunk of society has much less.

Incrementalism will only moderate dangerous trends, not reverse them, he writes. A State-by-State approach, while superior to doing nothing or taking small steps, could take a very long time, though it should be attempted if the political system will only allow halfway measures.

Whatever approach one prefers, however, all readers of this book should remember that every other advanced industrial country in the world has found a way to guarantee decent health care to all its citizens. Every year of delay is a year of higher costs and further intensification of America's unique private sector bureaucratic interference with medical treatment; and it is a year in which millions of Americans will suffer for the failure of their country to manage what every other nation of remotely comparable wealth and accomplishment has achieved."

"On health care Americans do not need new theory. International experience reveals the key measures. We can adapt those measures, and some of our own, and create an American system that can make us proud and secure in the new century," White emphasizes.

Competing Solutions. American Health Care Proposals and International Experience is available in cloth,. $38.95 (ISBN 0-8157-9364-2) or paper, $16.95 (ISBN 0-8157-9363-4). Order from the Brookings Institution at (800) 275-1447 or (202) 797-6258. For more information, contact Elizabeth Benevides at (202) 797-6107.