To address voters' concerns and reach the goal of health care for all, reform must guarantee comprehensive coverage for all residents as well as tackle the escalating cost of health care and ensure the highest quality of care possible. These areas - cost, quality, and access - are inextricably linked.
The following outlines the key values that any policymaker should incorporate into a comprehensive reform package tailored to their own state's needs, with the goal of achieving affordable, quality health care for all residents. The details will be covered in later sections, but these basic principles apply to any plan:
- Costs: One key is to limit costs, including deductibles and co-payments, to an affordable percentage of income, since patients who are sensitive to costs and face significant cost-sharing will forgo both necessary and unnecessary care, leading to delayed care and worse health outcomes. Maintaining employer participation and funding is also crucial to controlling costs, since employers still cover more than 158 million Americans, more than twice the number of Americans who receive Medicaid or Medicare. Creating a larger, merged pool of coverage lives achieves economies of scale, strong purchasing power, and negotiating leverage. And policymakers will have to challenge profiteering by health care industry players to keep costs down for consumers, including small businesses.
- Quality: Measures to improve the quality of care frequently reduce health care costs, and vice versa, including "pay for performance" and other systems that pay to keep people healthy, instead of simply paying for each service rendered. The staggering costs of chronic disease means that helping people stay healthy and reduce symptoms is critical to lowering health care costs and improving patients' quality of life. And given the inequity in US health care across racial, ethnic, economic, gender, and geographic lines, a particular focus on eliminating the sub-par care and worse health care outcomes for people of color and low-income and underserved populations is critical for improving overall quality.
- Access: Coverage should be comprehensive and include all necessary preventive, specialist, mental health, prescription drugs and hospital care, since studies repeatedly show that limited benefit or high deductible health plans cause people to act like they are uninsured. Coverage should be guaranteed and portable, meaning it follows you through life's events - personal relationships, new jobs, and retirement. A system that automatically provides residents with coverage is more likely to achieve universal coverage than a voluntary system or an individual mandate. Similarly, Americans value strong patient/doctor relationships, so maintaining the ability to choose the doctor you want to see and are most comfortable with is critical to achieving the political support for reform.
Public Plan Option: Absent a universal coverage system such as a single-payer plan, comprehensive reform should include a public health plan, ideally integrating the existing state Medicaid and other public plans, which is open to individuals and employers. A large public plan can use its leverage to negotiate lower costs and infuse the insurance market with quality competition, increasing options in the market for individuals and small groups.
- Herndon Alliance - Resources for messaging and communicating progressive health care reform, www.herndonalliance.org
- Families USA, the Herndon Alliance, AARP (Westen Strategies and Lake Research Partners) - How to Talk About Health Care Reform
Health Care Facts:
- Kaiser Family Foundation and the Health Research and Educational Trust, 2007 Survey of Employer Health Benefits
- Kaiser Family Foundation - Trends in Health Care Costs and Spending, September 2007
- Kaiser Family Foundation - State Health Facts
- Kaiser Family Foundation - Changes in Employer-Sponsored Health Insurance Sponsorship, Eligibility, and Participation: 2001 to 2005
- Robert Wood Johnson Foundation - Paying for Quality: Understanding and Assessing Physician Pay-for-Performance Initiatives