Connecting consumer choice to the healthcare system

American healthcare needs to be reformed into competing, efficient, comprehensive care systems. To get there from here, we need a health insurance market in which each person or household has a wide, responsible, informed, individual multiple choice of health care financing and delivery plans. The point of this is competing delivery systems, not just competing carriers. To compete, some carriers will create or contract with selective delivery systems or doctors selected for their quality and cost-effectiveness. Others will already be teamed up with large multispecialty group practices. On the other hand, high deductible plans will not help us get to a reformed delivery system.     

Managed competition of alternative delivery systems

The markets for health insurance and health care are not naturally competitive: they are susceptible to many forms of market failure. Health plans and consumers may use strategies that lead to inequity and inefficiency. But experience with successful models of competition suggests that tools are available to enable sponsors (active collective agents on the demand side who contract with health plans to structure and manage competition) to use competition to achieve a reasonable degree of efficiency and equity for their sponsored populations. All this implies a more complex, dynamic, and sophisticated view of competition than one usually finds in apologia for free markets. A free market is not possible in health insurance.