Excellus Health Plan, Inc.

One Small Step at a TimeAuthor(s): David H. KleinSource: Inquiry, Vol. 33, No. 3 (Fall 1996), p. 215Published by: Excellus Health Plan, Inc.Stable URL: http://www.jstor.org/stable/29772630 .

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From the Publisher

One Small Step at a Time

Evolution?not revolution?best describes the process for change most comfort?

able to our body politic. That is because revolution hurts too many people. We can

see evidence of this by comparing the recently enacted Health Insurance Portability and Accountability Act with President Clinton's failed Health Security Plan of 1994.

Absent catastrophe, public support for change declines as the scope of intervention

increases. This resistance to change occurs because the political resolve of those who

would be negatively affected by a proposal outweighs the resolve of those who would

be impacted favorably. Moreover, as the number of people harmed grows, the broader, and generally more ferocious, is the campaign to defeat the legislation.

Using the case in point, the Health Security Plan threatened to wholly eliminate the

commercial health insurance industry. This attack engendered strong reactions from

the insurance industry, including creation and broadcast of the now infamous "Harry and Louise" television ads. The lobbying and public relations campaign, combined with

some serious flaws in implementing and operating the program, led to the bill's demise.

In contrast, the political astuteness of Senators Edward Kennedy and Nancy Kassebaum is reflected clearly in the design of the Health Insurance Portability and

Accountability Act. Passage of the law aggrieved no group with potentially powerful

political influence. Medical savings accounts were really the only controversial issue, and that was resolved by allowing a limited demonstration project.

This is not to suggest that the act is devoid of accomplishments. On the contrary,

ensuring continuity of coverage across jobs and providing incentives for the

purchase of long-term care insurance are significant interventions.

At the same time, the act is not the ultimate panacea. A list of issues remains?the

affordability of health insurance, coverage of the uninsured population, cost of Medi?

care and Medicaid, to name a few. The lesson to be learned from this statute is to heed

politics and institute change incrementally. Some change is better than none at all.

David H. Klein

Publisher

Executive Vice President and

Chief Operating Officer Blue Cross and Blue Shield of the

Rochester Area

Inquiry 33: 215 (Fall 1996). ? 1996 Blue Cross and Blue Shield Association and

Blue Cross and Blue Shield of the Rochester Area.

0046-9580/96/3303-0215$1.25 215

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