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January 5, 1995


Arguments for retaining HealthAmerica

To the editor:

I am writing in response to the reports that the University of Pittsburgh is considering dropping the HealthAmerica health care benefits option for faculty and staff as a result of the offer from Blue Cross/Blue Shield to reduce its rates in exchange for becoming the sole benefits carrier. This proposition, however attractive on the surface financially (not an insignificant fact), is most troubling when given more thorough consideration.

Let me be open about my perspective on this issue. I am currently the editor of the Journal of Health Politics, Policy and Law, one of the major scholarly publications in the field. I am also a member of the Health Care Study Group, a collection of some of the most prominent health policy specialists in the nation, as well as the National Advisory Committee of the Scholar in Health Policy Research program sponsored by the Robert Wood Johnson Foundation. As an American Political Science Association Congressional Fellow, I served as a legislative assistant for health policy in the office of Senator Tom Daschle, where I participated in drafting the American Health Security Act introduced by Senators Daschle and Harris Wofford. Perhaps in recognition of this involvement with health policy issues, last year Chancellor Dennis O'Connor appointed me as a member of the Health Care Advisory Group chaired by Senior Vice Chancellor Thomas Detre. Therefore, my comments are not just those of a concerned faculty member and a current patron of HealthAmerica, they are also a reflection of considerable study given to the issue of health insurance coverage.

Frankly, I would prefer that the United States did not have an employer-based "system" of providing health insurance coverage. But it is currently, and for the foreseeable future, the reality in which we must all operate. Given that reality, how can we best live within it? Quite naturally, the University, like all employers, wishes to constrain its financial commitment to health care coverage, the cost of which continues to rise far faster than the general Consumer Price Index. Equally naturally, employees wish to maintain the best possible coverage at the lowest possible individual cost. The Blue Cross/Blue Shield offer may strike some as a reasonable option for securing both institutional and individual goals. But it comes with potentially serious negative consequences.

One of the worst aspects of the current health care insurance arrangements in the United States is that individuals have lost control over their access to care. Employers are constantly changing the benefit mix they offer, including eliminating coverage of dependents, elevating deductibles, and cutting back on the range of services covered. More importantly, employers are frequently shifting from one carrier to another, something of particularly major consequence when only one plan is offered and the plans involve managed care networks. Employees are left without any certainty about their health care arrangements, part of the "hollowing out" of America's tradition of "corporate welfare" that has left so many citizens feeling economically and socially insecure even during a period of economic expansion and rising employment.

Some might say that these problems are not associated with the possible Blue Cross/Blue Shield arrangements. That is true for now, but with two important exceptions: First, one thing that we know about optimal health care delivery is the importance of maintaining continuity in the relationship between patients and providers. Whatever the ultimate value of outcomes research and practice guidelines in standardizing care, the delivery of medical care remains a complex clinical task that is dependent upon the quality of the relationship and trust established between patients' histories. Indeed, it is an important social as well as clinical relationship, steeped in idiosyncratic as well as scientific attributes. Dropping HealthAmerica would prove tremendously disruptive to those University employees who have developed long-term and trusting relationships with not only their primary care providers, but also with even more essential physicians such as gynecologists and pediatricians who work directly for Health America and who are unavailable through Blue Cross/Blue Shield plans. As the father of a marvelous twenty-three month old daughter we adopted from an orphanage in St. Petersburg, Russia, I know that I would be outraged if an employer's decision forced us to leave the services of our pediatrician, whom we deeply trust and for whom we searched widely. Therefore, I am terribly concerned about all of those University faculty and staff who have established similar kinds of relationships with pediatricians who are available only within HealthAmerica.

Second, private monopolies in the health care industry hardly have a favorable historical track record. Short-term promise can soon turn into long-term headache. Employers are always switching carriers to achieve lower costs, only to find that the benefits of the change are temporary and then the bills go up and the options get squeezed. Perhaps given its size the University of Pittsburgh views itself as having enough monopsony power to ensure good behavior on the part of Blue Cross/Blue Shield, somewhat like the situation in Rochester, New York, but I am doubtful of this proposition. If that were the case, the University would be dictating the structure of the deal, not Blue Cross/Blue Shield. My guess is that the result down the road will be more instability in employee coverage, more churning through plans and coverage, greater disruption of physician-patient relationships and plans and coverage, greater disruption of physician-patient relationships and lowering the quality of care, and, ironically, little long-run success in restraining health care costs. Reports that one reads about businesses being successful at controlling their health care costs fail to emphasize that most of the cost "savings" really involve cost "shifting" to employees.

I am not prepared to do a commercial for HealthAmerica. Again, my preference, for a panoply of conceptually and empirically sound reasons, would be to treat health care coverage as an issue of social insurance and remove it from the domain of private insurance. But I think that the least reasonable option in the current setting is to give increased leverage to individual private insurance carriers, even noncommercial carriers such as Blue Cross/Blue Shield.

Mark Alex Peterson

Associate Professor

Public Affairs and Political Science


To the editor:

Regarding the probable change of medical insurance to exclusive Blue Cross-Blue Shield coverage: many employees in our office have been very satisfied with their HealthAmerica coverage and feel the University should not impose an exclusive insurer on employees. One suggested solution would be to "grandfather" HealthAmerica members, and to require exclusivity of only new University employees. This has been the tact taken by the University regarding other employment benefits. Why could it not also be the case as regards to health insurance benefits?

Carol A. Acrie

Administrator II


Paul H. Bramson

Director Division of Laboratory Animal Resources


To the University community:

Employees enrolled in the Non-contributory Defined Benefit Pension Plan recently received a letter from me regarding a "once-in-a-lifetime" retirement plan option. Let me clarify the option. If you are in the Non-contributory Defined Benefit Pension Plan, you must decide if you want to continue in this plan or change to the Contributory Tax Deferred Annuity Plan. You will have this "once-in-a-lifetime" opportunity to participate at 3% to 8% of your salary with a University match of 4.5% to 12%, and immediate vesting. If you do not choose to change to the Contributory Tax Deferred Annuity Plan by Jan. 27, 1995 but decide to convert during any future retirement open enrollment, you will be vested after three years, regardless of your previous years of service, and you will receive a one to one match for the first three years.

If you wish to make a change at this time, in order to receive the necessary materials, please visit or call (624-8160) the Benefits Section of Human Resources no later than Jan. 12, 1995.

Darlene Lewis

Associate Vice Chancellor Human Resources

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