Filling The Gaps In Health Insurance: Impact On Competition

Prologue: One of the nagging problems of a society that places a heavy emphasis on individualism and free enterprise is accommodating those people who lack the means to care for themselves. This issue has become a more pronounced problem in the 1980s because private and public payers alike have been attracted to marketplace approaches to medical care finance. Such approaches, by definition, seek to remove any elements of a transaction that represent a cross-subsidy. As a consequence, the traditional method of financing indigent care—burying these costs in the revenue stream generated by paying patients—is increasingly threatened by the movement toward competition. In this article, Gail Wilensky discusses the impact of competition on the uninsured, and also the impact of strategies directed toward the uninsured on competition. Wilensky is director of Project HOPE's Center for Health Affairs, a multi-disciplinary health policy center. The center is one of four organizations that have been officially designated by the Health Care Financing Administration (HCFA) as policy support facilities. As such, these centers are called upon by HCFA to analyze health policy issues that it must address in its capacity as manager of Medicare. Wilensky holds three degrees from the University of Michigan, including a doctorate in economics. A nationally recognized health services researcher and policy analyst, Wilensky was instrumental in the design and management of the National Medical Care Expenditure Survey (NMCES) while she worked (1975-1983) at the National Center for Health Services Research and Health Care Technology Assessment. More recently, her research pursuits have included medical indigency, the nursing shortage, and the relationship between health care financing and medical technology. Wilensky's center provided extensive technical assistance to the Department of Health and Human Services during its preparation of Secretary Otis Bowens report to the president on a Medicare catastrophic health insurance benefit.