Could we have universal health benefits by 2012? A non-partisan panel created by Congress to study what Americans want is urging just that. Pie in the sky? The politics of the issue–and this is all about politics, because Americans have been in favor of universal benefits for a long time–appear to be moving in the right direction at the moment.
The panel, the Citizens’ Health Care Working Group, was created by Congress with the task of determining what Americans want from the nation’s health care system, and formulating policy proposals. They found that 90% of citizens whom they met with wanted universal health benefits.
At this stage, CHCWG is calling for 90 days of citizens’ input; in September it will submit its final report. The President will be required to comment on their recommendations, and Congressional hearings will also have to be held. Could we be looking at the start of real reform?
This is a very serious development in the saga of Universal Health Coverage in America. First of all, the proposal to create a working group was a bipartisan idea.
Sen. Ron Wyden, D-Ore., said he and Sen. Orrin Hatch, R-Utah, came up with the idea for establishing a group that would work outside of Washington to find out what Americans want. He said they were tired of years of gridlock on health care issues.
“We decided, let’s try something else. Let’s go to the public and give them a chance, not in terms of writing a bill, but let them provide a kind of general roadmap where the country ought to head,” Wyden said….
Congress passed the bill creating the Citizens’ Health Care Working Group in late 2003. The same bill created a prescription drug benefit under Medicare. Congress approved $5.5 million to fund the group’s work, which began in February of last year. The group consisted of 14 members representing consumers, the disabled, business and labor, and health care providers.
These are the questions that CHCWG put to citizens in 31 meetings around the country.
I. What health care benefits and services should be provided?
II. How does the American public want health care delivered?
III. How should health care coverage be financed?
IV. What trade-offs are the American public willing to make in either benefits or financing to ensure access to affordable, high-quality health care coverage and services?
This page has a summary of the group’s interim findings. Virtually all citizens they met with agreed that the current health care system has serious problems. That is not news here, but it may be news to some who’ve had their heads in the muck of DC for too long.
Aside from the political question of how to keep private HMOs from once again wrecking this new health care reform movement, the most intractable question will be how to finance a system of universal benefits. Here is the summary of CHCWG’s findings on that question.
How should health care coverage be financed?
Although the results differed across meeting sites, a majority of participants (ranging from 55 percent to 88 percent in the community meetings) believed that everyone should be required to enroll in either private or public “basic” health care coverage.
In almost every community meeting, a majority of participants supported the notion that some individuals should be responsible for paying more for health care than others. The most commonly mentioned criterion for paying more was income, but varying payment by income was supported by the majority of participants in fewer than half of the meetings where this question was discussed.
Views about employer-based coverage did not generally reflect a deep distrust of employers, but instead were intertwined with broader concepts of health reform.
At most meetings, participants stressed the importance of preventive care to reduce health care costs.
Participants at most meetings believed that individuals have a responsibility to manage their own care and use of services.
In many meetings, participants mentioned that individuals have a social responsibility to pay a fair share for health care.
Participants frequently stated that the problems of high costs rest with “price setters”–namely, prescription drug companies, insurers, and for-profit providers.
A commonly expressed view was that a simpler system would result in lower administrative costs.
Some support exists for investment by providers and the private sector in health information technology to increase system efficiency.
Participants expressed general support for individuals’ playing their part in controlling utilization and costs.
Individuals would like information about how to use health care better and more effectively.
At some meetings, participants supported providing incentives to patients to engage in healthy behaviors.
Participants expressed preferences for using medical evidence to decide which services are covered and provided.
There was general support for controlling prescription drug costs by limiting direct-to-consumer advertising of prescription drugs and using more generic drugs.
Support also existed for limiting expensive yet “futile” end-of-life care and instead providing palliative care.
In almost all community meetings, participants expressed the belief that changing the culture from sick care to well care–namely, by focusing on prevention, wellness, and education (in general, and health education in particular)–will reduce health care costs.
A commonly expressed view was that better use of advanced practice nurses and other non-physicians could save money and improve quality.
Participants believed that investing in public health would pay dividends in terms of reducing health care costs.
Support for limits on malpractice was expressed at some community meetings.
It is remarkble, first of all, that people agree in several ways that a nationalized system will reduce everybody’s costs. Another of the most important points to come out of this group’s work, and one that is being repeated in the news stories that have appeared so far, is this: “Individuals have a social responsibility to pay a fair share for health care.”
When meeting participants at all meetings were asked, “Should it be public policy that all Americans have affordable health care coverage?”, 94 percent overall said “yes.” Similarly, in the Working Group’s Internet poll, 92 percent either strongly agreed (80 percent) or agreed (12 percent) with this statement. Over 90 percent of participants at community meetings and respondents to the Working Group’s Internet poll believed that it should be public policy that all Americans have affordable coverage. As stated by participants in the Orlando community meeting, “Health care is a right and not a privilege.” Seattle, Denver, and Philadelphia meeting participants, among other locations, desired “cradle to grave” access to health care.
The Summary of Findings is exceptionally detailed and admirably laid out. Everybody should read it in full. That’s not an assignment; it’s a privilege of citizen activists to have a group such as this working on our behalf.
Then let’s talk about the Interim Recommendations. In summary, they are as follows:
Recommendation 1:
It should be public policy that all Americans have affordable health care
Recommendation 2:
Define a “core” benefit package for all Americans
Recommendation 3:
Guarantee financial protection against very high health care costs
Recommendation 4:
Support integrated community health networks
Recommendation 5:
Promote efforts to improve quality of care and efficiency
Recommendation 6:
Fundamentally restructure the way that palliative care, hospice care and other end-of-life services are financed and provided, so that people living with advanced incurable conditions have increased access to these services in the environment they choose
Personally, I find nothing very remarkable about the group’s findings or its recommendations. What is remarkable is that it has taken the U.S. sixty years to come to this position, since Harry Truman proposed creating a universal health care system. If the federal government is responsible for ensuring our safety from external enemies, why should it have no interest in making internal medicine available to all?
Whatever you do this weekend, make sure you comment on the CHCWG proposal. This period of public comment is critical to the group’s ability to leverage its findings and recommendations in Congress. If we get behind this now, we may find that we have a real chance to get some version of universal health benefits passed into law.
I can tell you, there are millions of Americans who would be relieved and grateful. Count me among them. My wife and I have had no medical insurance for nearly a year, though we are both employed. Why should that be?
Crossposted at Daily Kos