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This article was originally published in The Gray Sheet

Executive Summary

CLINTON HEALTH TASK FORCE: WORKING GROUP ON BENEFITS PACKAGE is headed by HHS Senior Health Policy Advisor Judith Feder, who headed the transition team's health branch, and Atul Gawande, who was her deputy. The panel looking at benefit packages is one of 28 working groups that will make policy recommendations to the task force. The task force will consider the groups' recommendations as it formulates a series of health care policy options to be presented to President Clinton, who will ultimately determine what is included in an Administration legislative proposal. In addition to the several hundred departmental employees working on the task force staff and in the working groups, many consultants are being brought in on three- to four-month contracts; they are required to sign an ethics pledge promising they will refrain from lobbying the government for six months after completing their consultation work. Several members of the Jackson Hole group, including Stanford economist Alain Enthoven and the Boston Consulting Group's Thomas Pyle, are among the consultants. Clinton is telling task force members that he wants to present comprehensive health reform legislation to Congress by the first week in May in order to fulfill his campaign promise of a reform plan within the first 100 days of the Administration. The task force's working groups will include congressional Democratic staffers but not representatives of special interest groups, Administration officials maintained at a Feb. 12 briefing on the health task force. However, officials say, consultation with interest groups as well as consumers will be used to gauge whether the policy recommendations in development are realistic politically and practically. Administration officials noted that many physicians and other health professionals from both inside and outside government are part of the policy formulation effort. The working group recommendations are being formulated using a seven-step "toll gate" process that has been used in the private sector when large initiatives must be undertaken within a brief time period. The groups already have completed the first phase, which involved identifying the questions they intend to answer, the individuals they will contact and the data they will seek. Currently, the working groups are in the second phase. The objective of this phase is to gather a wide array of policy options. In the third phase, options will be presented to task force members and synthesized. The working groups will narrow the options in the fourth phase and present draft recommendations to the task force. At this point, the working groups must explain all assumptions that support their conclusions. Working group recommendations will be synthesized into a comprehensive set of proposals in the fifth phase. The recommendations will be audited externally in the subsequent phase, as the proposals are analyzed for any potential legal problems, incorrect numerical projections or assumptions, and possible political problems. It is during this phase that "contrarians" attempt to point out the weaknesses of each proposal. The last toll gate consists of a final review of the legislation and final audits of the synthesized proposals. As the working groups proceed through these toll gates, working groups could be consolidated or additional ones formed as deemed necessary. First Lady Hillary Clinton, the chair of the health task force, will meet with Democratic and Republican House members on Feb. 16; she met with Senate leaders Feb. 4. The First Lady speaks daily with task force and working group members, officials said, adding that her primary mission is to build a consensus around the recommendations that the task force will present to the President.

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