Holes in the Jackson Hole Approach to Health Care Reform

MANAGED competition is synonymous with market-oriented health care reform. Those who coined the phrase, the Jackson Hole Group,1have been identified, incorrectly, by theNew York Times2as the brain trust for the Clinton administration's reform proposal. Many medical industry groups have participated in developing the Jackson Hole version of managed competition, including major insurance companies, the American Medical Association, the Pharmaceutical Manufacturers Association, and large health maintenance organizations (HMOs). About the only significant interest groups that have not expressed support for the concept are those representing consumers. In this article, we critically assess the Jackson Hole Group's proposal to control health spending and provide access to quality health care. Boiled down to its fundamentals, the Jackson Hole approach to managed competition requires three major changes in the US health insurance system. First, regional health insurance purchasing cooperatives (HIPCs) are formed to manage the marketplace for health care