Paul Starr

Paul Starr is co-founder and co-editor of 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 eight books, including Entrenchment: Wealth, Power, and the Constitution of Democratic Societies, which will be out next year.

Recent Articles

How Low Can You Go?

How to Zero Out the Debt J . Fife Symington III, the Republican governor of Arizona, is so conservative that he has sought to abolish the state's Depart ment of Education. But, poor fellow, he's broke, as the Economist recently reported. When he was elected in 1991, Symington said he was worth $10 million. Three months later, he claimed his net worth dropped to a negative $23 million. These things happen. This past fall, in an unprecedented step for a sitting governor, Symington filed for bank ruptcy protection under Chapter 7, which allows him to stiff his creditors and get a fresh start in life. Now this is an imaginative new idea in state fiscal policy. Many conservatives say they are opposed to debt; only Symington has shown how to get rid of it entirely. We all sometimes need a fresh start, governments included. And Symington is doing it in a way that demonstrates personal responsibility by protecting home and family. His home is in his wife's name, and her fortune is beyond the...

Healthy Compromise: Universal Coverage and Managed Competition Under a Cap

A promising strategy emerges to break the impasse.

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...