EBRI Issue Brief

Health Care Reform: Tradeoffs and Implications

Apr 1, 1992 59  pages


This Issue Brief describes the various proposals that have been offered to reform the health care delivery system; examines estimates on how each proposal would affect the coverage, costs, and quality of health care; and places each proposal in the context of the tradeoffs inherent in health care reform. The report attempts to describe proposals along the entire spectrum of health care reform plan types including those that have been advanced by members of Congress, research analysts, trade associations, and academics. The analysis explores expansion of continuation of health insurance coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985, medical malpractice reform, small group insurance market reform, tax-based reform, public program expansion, employer mandates, play-or-pay employer mandates, managed competition, individual mandates, and national health insurance systems.

Quantitative analyses draw on a variety of studies and EBRI's own estimates. The studies provide order-of-magnitude effects rather than precise estimates of costs and benefits. The estimates are valuable, however, in illuminating the tradeoffs inherent in enacting any of the reform proposals. Although health care reform proposals attempt to expand access, improve quality, and/or reduce costs, no delivery system can accomplish all of these tasks simultaneously. This Issue Brief describes who could gain coverage and who is likely to switch from one source of coverage to another under alternative reform scenarios. As a result of improved coverage, costs are likely to increase or at least be redistributed. The change in total costs and the allocation of these costs among employers, employees, government, and taxpayers are discussed. Finally, the effects of changing the health care delivery system on the quality of care are explored throughout the report.