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Competing Solutions

American Health Care Proposals and International Experience

By Joseph White

With health care reform at the top of the domestic agenda, this volume assesses the Clinton administration’s proposals and several alternative plans by discussing how six other countries have organized health care finance and delivery to achieve universal access to comparable quality care at much lower costs. The six countries examined—Australia, Canada, France, Germany, Great Britain, and Japan—reveal both the variety and fundamental similarities of medical care systems in the rest of the industrialized world.

Joseph White uses foreign experience to indicate the proper direction for American reform and to identify interesting alternatives that suggest compromises for what are usually presented in the U.S. as “either-or” choices. Examples include the role allowed for private insurance within all national systems; exceptions to fee schedules in Australia, France, and Germany; and the complaint mechanism for malpractice in New South Wales.

White begins by describing each country’s system and then follows with chapters disucssing three classes of problems. “Quality and Access” uses the experience of other countries to establish a reasonable baseline for what the U.S. should aim to achieve. “Collecting the Money” discusses who pays and how. “Controlling Costs” explains how other countries have moderated their cost increases.

The final chapter assesses American reform proposals in light of the foreign evidence. White argues that a synthesis of “competition” and “regulation” is possible and that such a synthesis is approached by the Clinton proposals. But he also identifies areas where those proposals fall short or risk collapsing of their own weight. He concludes by comparing the administration’s proposals to the major alternatives.

“This book is serious scholarship at its best. Comprehensive in scope, insightful in character, and compelling in its reasoning, the book presents a balanced treatment of alternative proposals.”—Choice

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