Competition and the Pursuit of Quality: A Conversation with Walter McClure

Prologue: Issues surrounding health care costs and quality are in many respects indistinguishable, if not always compatible. The pursuit of solutions to these issues is moving forward on a variety of fronts at the national, regional, and local levels. In this interview, Walter McClure describes his odyssey at the local level in striving to persuade interests there that unless they become active agents for constructive health care reform, government will eventually assume command of the system. McClure holds a bachelor's degree from Yale University and a doctorate from Florida State University in theoretical nuclear physics. McClure left the discipline of physics and took up health policy research in 1969, for reasons having to do with “relevance,” his resume says. For twelve years (1969–1981), McClure worked at InterStudy, a Minneapolis-based think tank founded by Paul M. Ellwood, Jr., another leading advocate of the market model in health care. In 1981, McClure departed InterStudy and founded the Center for Policy Studies, which also is headquartered in the Twin Cities. Throughout much of the 1970s, McClure and Ellwood devoted considerable time to striving to influence the directions of federal health policy. After countless trips to Washington, they became persuaded that they had to widen out their pursuit of transforming health care through the broader application of market principles. Thus, they both devoted themselves to persuading private purchasers of medical care of the efficacy of the market model. McClure developed what has become known as the “buy right” strategy, an approach that seeks to convince purchasers and providers that their enlightened self-interest is best represented by encouraging the promotion of care that is reasonably priced and of high quality. To pursue this strategy, McClure has become an evangelist at the local level, deploying the resources of his organization as essentially a community organizer. Working most actively in the state of Pennsylvania, the center seeks out key members of a community s power structure in an effort to convince them that the most effective route to cost-efficient health care is through a decentralized, competitively based model.