LESSONS FOR THE HEALTH-CARE INDUSTRY FROM AMERICA EXPERIENCE WITH PUBLIC UTILITIES

In the United States, the traditional public utilities, power and tele communications, along with health care, are being deregulated and beco ming increasingly competitive, especially on price. Regulation of the public utilities has occurred for the past century not simply because they have been monopolies, but, more importantly, because they are ''i ndustries affected with the public interest,'' that is industries whic h: 1. provide an essential service, 2. benefit from public perquisites , and 3. would cause great public harm if mismanaged. Consequently, th e presence of competition in these industries does not negate the need for regulation. Regulation of these industries is best understood as being along the three sides of a ''triangle of public interests''-qual ity; public accountability, and universal service. Examples are provid ed of these types of regulaton in power and telecommunications, even i n current ''deregulatory'' legislation. Health care reform activists i n the United States have lately paid attention mostly to the first two legs of the triangle; they are encouraged to focus creatively on the third leg-universal health care.