Private sector actors and states alone cannot address the concerns we identified. The private sector lacks the potential for generating legislative authority to require compliance that is inherent in government. Also--and perhaps of greater relevance--the private sector does not perceive itself to have the resources or scope of influence over components and players in the health care system required to collect needed information. States have an important role to play, but resources also limit their activity. Further, the increasing consolidation of the health system means that individual state initiatives cannot address user needs which cross state lines. For example, these include national purchasers that want consistent information for health plans in diverse states or consolidated health systems spanning state lines.
There are a number of reasons for federal leadership in addressing these issues. First, as highlighted in Chapter III.A, the federal government is a major funder of information collection activity on the supply side of the system. While federal spending may here may pale in contrast to the spending on population-based surveys, the federal government remains a major funder of information systems on health care providers and their services. HHS has a fiduciary responsibility to the tax payer and Congress to assure that its efforts are well spent and focused on issues of greatest priority. Second, the current decentralization of authority and involvement in data collection on the health system, complicates the task of addressing data gaps which span multiple governmental jurisdictions and the defacto scope of influence of diverse private sector constituencies. This creates a need for leadership that is well-suited to the federal government and its potential to collaborate on convening multiple parties. And third, the ERISA pre-emption means that on key issues involving health insurance/health plans, states are often handicapped by their inability to bring in self-funded plans. HHS involvement not only can help bridge this gap but also can encourage a focus on health policy needs when insurance departments and labor address issues of health insurance information.