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February 14, 2012

By Gary A. Puckrein, PhD

Doctors and nurses walking down a hallway

From The Democratization of Health Care Series

Posted December 15, 2011 | Updated February 14, 2012

By Gary A. Puckrein

Published on The Huffington Post

In the pre-release preface to Essential Benefits: Balancing Coverage and Cost, the Institute of Medicine articulated the purpose of the report as giving guidance to the secretary of health and human services regarding the “essential health care benefits that must be offered to individuals and small groups in state-based purchasing exchanges and the existing market.” The report attempts to balance the arguments advanced by groups representing providers and consumers, who urge the broadest possible coverage of services, against groups representing small and large businesses, who are pushing for affordability and flexibility.

This is not unfamiliar territory for our government. Since 1965 it has defined minimum benefits for Medicare and Medicaid. What is uncharted territory, however, is the federal government’s venturing into the previously sacrosanct domain of private/commercial health insurers, whose ability to exercise great latitude in defining beneficiary benefits is at issue. As we move toward government-authored definitions, it might be helpful to take a step back to examine the forces that have brought us to this place and to revisit what we are actually trying to accomplish. 

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