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IS THE HEALTH CARE QUALITY advisory commission that President Clinton named last week a political gimmick, as some Republicans charge, or a sound mechanism to examine the nation's health care delivery system?
We certainly hope it is the latter and are inclined to give Secretary of Health and Human Services Donna Shalala the benefit of the doubt when she says the 34-member commission wants to create a structure to allow all health care stakeholders to examine critical issues without a climate of confrontation. Ms. Shalala will chair the commission.
The commission, she said, is likely to meet monthly and make interim recommendations as it goes along.
There is a tendency in some quarters to dismiss commissions-as has already occurred with this one-as having little real clout or as merely a convenient way for an administration to advance its own agenda.
Commissions have, in fact, at various times laid the foundation for necessary future change. Back in the early 1980s, for example, a bipartisan commission established by President Reagan put together-with thought and care-a sound series of recommendations that became the basis of a legislative package passed by Congress that removed the imminent threat of insolvency from the Social Security program.
What commissions can do is study issues and come to conclusions without the looming deadlines politicians often face and without the need to pander to political constituencies. That means, when things go right, decisions and recommendations can be made on the basis of the best information available.
In the health care arena, anecdotal evidence and lobbying by interest groups unfortunately often has been the basis of legislation. At the state level, the hundreds of health care mandates, specifying what kind of benefits health insurers must offer, have had far more to do with the power of specialized interest groups than good public policy.
And in Congress, anecdote, not analysis, often is the trigger for intervention. This year's cause celebre, for example, is banning so-called drive-through mastectomies, in which managed care plans supposedly are not even allowing women to spend the night in a hospital after the procedure. To hear the discussion, one could think such a practice-admittedly reprehensible-is the norm among managed care plans rather than the rare exception, which we believe is the case.
Lobbying and anecdote is no way to frame health care policy.
We hope this commission critically examines the best information available and then decides what, if any, legislative initiatives are needed to better assure that health care plans deliver quality services without unnecessarily driving up employer costs or crippling the plans with cumbersome rules.