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Contact Us Fall 2000; Volume 1, Number 1

Editor's Note

The sensitivity of this country to health care issues is without question. It was only 6 years ago that health care proposals initiated by the Clinton White House caused such controversy within our government, and such confusion and anxiety amongst the public, that the Republicans were able to re-gain control of the House of Representatives. Moreover, as this letter is being written, health care issues such as Medicare reform, prescription drug benefits, and the "Patients' Bill of Rights" continue to be central issues in the 2000 Presidential campaign.

The exact direction of our health care system, however, is unclear. Many would like to see universal health coverage. As worthy as this goal may be, rumors of either the impending birth or death of a universal health care system are, to paraphrase Mark Twain, exaggerated. No one has yet to succeed in cohesively knitting together the many players in this field (the federal government, state and local governments, commercial enterprises, non-profit organizations, research institutes and individual practitioners) in a way that has motivated this country to enact and implement such a system, even in these prosperous times. In fact, there is not even a consensus as to the next steps to take. Clearly, these issues will be with us for a long time to come.

Unfortunately, many health care problems are as poorly understood as they are important. In addition, there is an all-too-human tendency to view these problems from a parochial perspective, thereby creating an environment where one loses sight of the merits of contrasting views, not to mention the political hurdles to potentially achievable solutions.

The Harvard Health Policy Review (HHPR) is dedicated to broadening the understanding of health policy issues, not only among those who work in this area, but also beyond the academic community to the broader public at large. Each issue of the HHPR will include papers by students, both graduate and undergraduate, and by recognized experts in their fields. In-depth analyses of particular issues and brief summaries of topical subjects will be offered. Finally, we plan to have each issue focus on a major subject through a series of articles giving different perspectives on this single theme.

For this, our inaugural issue, the choice of theme was not difficult: the impending Presidential election. To help our readers develop a solid grasp of the importance of this election to the future of health care policy in this country, we have included Professor Robert Blendon's overview of the election, Junior Fellow Jacob Hacker's historical discussion of health care reform, and Professor David Blumenthal's article entitled, "Health Care: Does It Matter in the Presidential Campaign?" We are also fortunate to have been granted interviews by the leading health policy advisors to both the Bush and Gore campaigns. The result is, I think, a readily understandable, and relatively comprehensive, treatment of the health policy issues that are foremost in the minds of Americans today.

As our readers will learn, the two Presidential candidates have substantially different perspectives on health policy issues. Both understand the problems. Both are willing to spend substantial sums of money to provide better health care for the entire U.S. population. Concerning the means to this end, however, there are major differences of opinion. To what extent should government agencies, both federal and state, be entrusted with this job? To what extent can competition and other market forces be enlisted in this effort? Who should make the decisions on such delicate matters as who should qualify for what treatments, and who should pay for them? The list goes on.

Many of the issues central to the political debate are treated in separate articles. These include discussions on: the politics of Medicare prescription drug coverage, the problems of the uninsured, and the "Patients' Bill of Rights." Other critical health policy issues that have not received quite so much attention in the Presidential campaign are also analyzed. These include: improving patient safety, the composition of primary health care delivery, Medicare HMOs, ERISA as a shield against HMO medical liability, and trends in employer-based insurance coverage. Finally, to help our readers understand the many acronyms and other specialized terms without which discourse in the area of health policy is impossible, Sheila Burke has contributed a helpful Glossary.

The staff would like to thank the authors for their contributions, and our faculty advisor, Dr. Frank, for his comments. We also thank our Board of Advisors and the Harvard Interfaculty Initiative in Health Policy for their participation, with special thanks to Joan Curhan for her unfailing encouragement. Lastly, we are deeply grateful to our financial sponsors. This journal would not be possible without the support of everyone above. As we go forward, we welcome all comments from our readers.

Clay Ackerly
Editor-in-Chief
Fall 2000

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