Florida attacks health care problems.

• Author: Moss, Bill
• Position: Includes related articles

Florida lawmakers chose to "make dust" rather than "eat dust" by reforming health care in their state before the Congress acts.

Florida lawmakers hope they have found a public-private solution to the health care crisis.

Pushed by Governor Lawton Chiles, the Florida Legislature in April enacted a sweeping model for heath care reform based on the idea that businesses pooling their buying power can obtain quality health insurance at affordable prices.

The managed competition approach places Florida in the forefront of states trying to solve the problem that threatens to consummate state budgets and sink small businesses.

"This is a great model for managed competition," Chiles said the day after the Legislature passed the 186-page bill. "We have everything in this we thought we needed."

The bill also:

* Sets up practice parameters, or guidelines to show doctors the most cost-effective proven treatments to get the best results for hundreds of medical conditions.

* Encourages hospitals in rural areas to cooperate in networks through which some would specialize in emergency care, others critical care and others convalescent care.

* Encourages public hospitals receiving state money for providing indigent care to expand primary care clinics.

While most states face growing budget pressures from the health care quandary, the problem is even greater in Florida. Of the state's 13.5 million residents, 2.5 million--18.5 percent--are uninsured. When medical problems become acute, the uninsured get attention in hospital emergency rooms where costs are the highest.

Floridians spent $31.4 billion on health care in 1990, and the number is expected to rise to $90 billion by the end of the decade if nothing is done. Doctor bills for Medicare patients in Florida are the highest in the country, according to a recent study in the New England Journal of Medicine.

Florida's health care reform was launched last year when the Legislature began plans to develop health care for everyone by 1995. In his State of the State address on the Legislature's opening day, Chiles challenged lawmakers to act swiftly on his health care reform plan.

"We can't wait for a national plan that will delay our ability to provide access to people who need it," he said. "We can show the way. We can make dust or eat dust."

Lawmakers chewed plenty on Chiles' plan before they finally swallowed it.

The most fiercely fought piece involved the community health purchasing alliances (CHPA)...