Health Care Choices: Private Contracts as Instruments of Health Reform

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How can decisions about health care in the United States - too long dominated by providers, government, and the legal system - be put back into the hands of the people? Clark C. Havighurst contends that private contracts can be sharpened to do just that and ensure universal coverage, too. Private contracts, the author states, would allow for more and genuine consumer choice, based on real differences among competing health plans in content, coverage, and cost of services. Contracts would establish the standards and obligations of all parties - instead of the courts relying on definitions of care borrowed from the medical profession that drive health plans to overspending. Voluntary economizing would replace rationing without consent. Contracts could cure a dysfunctional health care market and end a severe misuse of U.S. resources. Often with specific contract language, Mr. Havighurst offers organized health plans, employers, purchasing cooperatives, Congress, and the courts ways they can turn private contracts into effective instruments of consumer-driven health reform. He recommends explicit recognition of contracts in any health reform legislation. With changes in how health coverage is purchased, courts would respect freedom of contract. And better health care contracts could be the key to designing an appropriate and affordable form of universal coverage.

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