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Medicare: New Directions in Quality Assurance
cal dependency services. I visualize that the basic benefit package would be subsidized in some manner and include some prescribed cost sharing. Any other health services purchased beyond the basic benefit covered package would be the individual's or employer's particular choice.
Having a national-level benefit package means that all persons are covered, including those who may be heavy users of the health care system. This, in itself, would address many of the currently unresolved access problems for the uninsured or for those who have high-cost illnesses and diseases and are unable to obtain coverage for pre-existing conditions.
My reform package begins with catastrophic coverage. We learned through the unsuccessful efforts to add catastrophic coverage to Medicare that we need to educate the public on what they are buying through insurance and to make them aware of what they are not buying. Americans need to understand the role they are playing—through purchasing insurance products with extensive benefit packages—in supporting and promoting the high cost of health care in America. The dissatisfaction with health care cost is as much my problem as a consumer as it is the problem of the insurance companies, the doctors, the hospitals, or anybody else. Until we, the consumers, understand that we are all part of the problem, we, the reformists, are not really going to be able to do all of the things we need to do to correct the problems.
We need happy doctors in order to have quality care. Doctors must feel that they are doing what attracted them to practice medicine in the first place. For this to happen, the consumer—the patient—needs to better understand his or her role in the health care system.
Institute of Medicine. Medicare: A Strategy for Quality Assurance. Volumes I and II. Lohr, K.N., ed. Washington, D.C.: National Academy Press, 1990.