It began as a seemingly "fair" competition. The match-up was individual against doctor--company against insurance. In theory, the struggle between these elements would produce mutual gains; doctors and insurance companies could make a profit, and individuals and employers would receive reasonable health care and coverage. While appearing to be an equitable contest, on flaw remained. Government did not possess a role--there was no referee. Without the presence of an overriding authority, medical care and coverage could play without rules and without control. In a competition gone awry, the individual and his employer have either been seriously thrashed by the exorbitant costs of health care or forced to give up the right and live without insurance. The absence of government has equated with a lack of justice or fairness within the health care industry.

In order to realign the operations of health care and insurance, government must assume its role as arbiter. The construction of rules and regulations could provide the necessary structure for securing both quality care and essential coverage. Lastly, government could insure each working individual his "fair share" of health insurance with a compromise edition of the "play or pay" plan. The transition of the United States government from bystander to referee could result in a health care system which is equitable for all players.

The capitalist background of Americans instinctively forces individuals to view governmental interference as a negative action; however, it is often a necessity. Government involvement in the power, cable TV, and the telephone industries has traditionally prevented monopolies from taking advantage of Americans. Government has consistently stepped in when the free market system unjustly harms consumers. The realm of medical care and insurance has virtually functioned without the imposition of governmental control, but yet both have failed to be feasible within the workings of a market economy. Normal factors such as competition, or supply and demand, have failed to phase the cost or quality of the health care system.

The competition between private insurance markets in the 1980s resulted in the soaring of rates and the decline in coverage. An increase in the number of doctors and surgeons has failed to give patients the upper hand in the prospect of price control. Alan C. Enthoven, a professor at Stanford University's Graduate School of Business states: "Health care has been dominated by the supply side. We need to strengthen the power of the purchasing side." The only way to do this is to implement government controls. These must force insurance to respond to critical consumer needs. The government establishment of a minimum insurance coverage package, as well as its maximum price is fundamental fo producing reasonable health insurance. Approximately one million Americans a year lose their health insurance due to cost increases, and it is estimated that between 15-70 million Americans are uninsured. The action of cost increases results in the vicious cycle of individuals and businesses opting for less coverage. The creation of governmental guidelines concerning cost and coverage could end this cycle.

The control of health insurance costs is beyond the reach of the average American. The control of general medical expenses is even further from his grasp. It is nearly impossible for the health care system to function like a real market since the services rendered are an unavoidable need. Even if individuals had more opportunity to "shop around," they lack the capability of determining what constitutes a reasonable expense. In the past, medical costs were overlooked because insurance insulated patients from the cost; however, the recent rise in insurance premiums is directly linked with the increase in general health care costs. The intervention of government is once again necessary to harness a system which is out of control. Senate Majority Leader, George Mitchell, proposes to create a Federal Health Expenditure Board to set national health spending targets. This would not only provide Americans with a guideline for reasonable costs, but it would also provide national regulation for the containment of health care expenses.

Government must supply the rules and regulations for America's system of health care. Its second responsibility is to insure fairness--to guarantee everyone his "fair share" of insurance. Even with governmental controls on health costs, every American needs insurance. Currently the vast majority needing health insurance are those in the workplace; 85 percent of the 33 million uninsured are worker and their dependents. A "play or pay" plan would provide coverage to this percentage, since employers would be required to either supply insurance or pay a tax. In order to be feasible, this plan must be modified to incorporate the employees of large and small businesses, as well as those who are self-employed. When dealing with large industry, government must encourage employers to "play" rather than "pay." It would save the United States a lot of bureaucracy and a lot of money. The "pay" option for large businesses will have to be quite steep in order to be self-supporting. Through the promotion of the "play" option, workers will receive insurance without posing a burden on the government.

When dealing with small businesses, however, the approach must be modified. These businesses cannot be expected to be able to "play," but yet they cannot withstand to be severely penalized when they "pay." The Business Week proposal suggests that these employers pay a payroll tax, with a surcharge based on the company's profitability. The money would go to a nonprofit health care purchasing corporation, which would buy coverage for these companies. Those who are self-employed, would buy their insurance directly from the corporation. This governmental involvement would insure small businesses the opportunity to supply equitable coverage to employees without going broke. This plan would be the most feasible for the U.S., because it insures coverage to all workers without government assuming the sole responsibility. It would also leave the health insurance industry intact, which would lessen the confusion of health care reform. Most importantly, "play or pay" gives each worker the secure knowledge that he is guaranteed insurance.

It is undeniable that health care and coverage is a simple system. Nevertheless, government must attempt to bring order to the confusion. The American consumer has been brutally beaten in the game of health care, which refuses to function like a market economy. The United States government must provide fairness; it must guarantee that each worker receives health insurance. A "play or pay" plan would accomplish this without government assuming total control. Within the spectrum of health care, government intervention is a critical necessity. By assuming its' role, government can transform the health care and insurance industries into a system which plays by the rules.

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