Paul Starr

Paul Starr is co-founder and co-editor of the The American Prospect. and professor of sociology and public affairs at Princeton University. A winner of the Pulitzer Prize for General Nonfiction and the Bancroft Prize in American history, he is the author of seven books, including most recently Remedy and Reaction: The Peculiar American Struggle over Heath Care Reform (Yale University Press, revised ed. 2013). Click here to read more about Starr.

Recent Articles

Healthy Compromise: Universal Coverage and Managed Competition Under a Cap

T his is how the system might work: You would get your health insurance through a new, regional health insurance purchasing cooperative. The purchasing cooperative, bargaining on behalf of large blocks of subscribers, would contract with a variety of private health plans, including health maintenance organizations (HMOs), preferred provider plans, and one conventional free-choice-of-provider option. Each plan would have to offer a standard, mainstream benefit package to every prospective enrollee. Once a year the purchasing cooperative would ask you to choose among the health plans (or "networks," as Bill Clinton calls them) and inform you about their monthly charge and quality of care, including consumer satisfaction. Money would flow into the cooperatives from employers and employees, from other people according to their ability to pay, and from government. Money would flow out to the health plans according to their enrollment: The purchasing cooperative would pay each plan a...

Detoxifying the Debate

A s an art form, caricature is fun. The caricature of ideas, however, does not have the same appeal. And when the caricaturists seek to arouse fears and anxieties by distorting unfamiliar ideas into misshapen and threatening images of insidious evil and betrayal, they do public debate and even their own case a great disservice. In an article in the previous issue ("Healthy Compromise: Universal Coverage and Managed Competition Under a Cap," TAP Winter 1993), I presented a proposal for universal health insurance through new, regional health insurance purchasing cooperatives, which would represent the consumers and employers who pay for health care and be responsible for keeping the growth of health spending within a nationally set budget limit. The purchasing cooperatives would negotiate with competing health plans over costs and services, provide consumers information about their alternatives, conduct an open enrollment, adjust the total payments to plans in line with the risk of...

Delivering Health Reform

Can the Clintons find the votes for health care reform without wrecking the logic of universal coverage, cost-control, and managed competition?

The Social Security Act in its final form was far from a perfect piece of legislation. In important respects it was actually weaker than the Wagner Lewis bill of the year before. It failed to set up a national system and even failed to provide for effective national standards. It left to the states virtually every important decision and thus committed the nation to a crazy- quilt unemployment compensation system. . . . For all the defects of the Act, it still meant a tremendous break with the inhibitions of the past. The federal government was at last charged with the obligation to provide its citizens a measure of protection from the hazards and vicissitudes of life. Arthur M. Schlesinger, Jr., The Coming of the New Deal I mperfect, but a landmark on the journey to a good society: so it will be with health care reform, if we are lucky. The window of political opportunity for universal health coverage has opened five times in the twentieth century, and each time legislation has failed...

What Happened to Health Care Reform?

Republicans killed it. The White House strategy misfired. Reformers couldn't unite. The center failed. And the moment was lost.

I t was one year from euphoria to defeat. On the evening of September 23, 1993, I sat in the gallery of the House of Representatives for President Clinton's speech introducing the administration's Health Security plan. For those of us who had worked on it, this was the climax of a long, intense, and not always easy collaboration. I had been one of about ten people on the health policy team in the White House who had written and rewritten the plan after the cast of hundreds had left. Now the president had the nation's attention focused on ideas we deeply believed in, and he spoke with tremendous force. At first it seemed Clinton would move the country. The next morning, Stanley Greenberg, the president's pollster, crowed that the overnight surveys showed we were winning two-thirds approval. Commentators were saying that no matter how the battle over details might work out, the president had established the right principles and challenged Americans to a great, historic mission. The...

How Low Can You Go?

THE SOCIAL BENEFITS OF PREMATURE DEATH One argument for a sharp increase in tobacco taxes is that it would force smokers to pay for the increased medical costs they generate. But some economists say higher medical costs are only half the story. Peter Passell wrote last July in the New York Times that "a full accounting must also include the savings from smoking. Yes, savings: the reduced cost of private pensions, Social Security and nursing home care for smokers who die before their time." And on a full accounting, according to studies cited by Passell, the social costs of smoking may be too small even to justify current taxes, much less an increase. The economists making these arguments are breaking new ground. Public policy has always generally made the assumption that life is a benefit and worth preserving. But, on a "full accounting," a lot of people--particularly old people--are clearly more cost than benefit. So a policy that encourages them to kill themselves, such as low...

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