Providing Universal and Affordable Health Care (1989) / Chapter Skim
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Providing Universal and Affordable Health Care to the American People: Private Sector Perspectives
Providing Universal and Affordable Health Care to the American People: Private Sector Perspectives
Pages 32-41
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From page 32... ...
In fact the Rosenthal Lecture title suggests something of the definition I would use, emphasizing as it does the terms "universal" and "affordable." My thesis is that universal financial access to care -- or national health insurance in some form -- is now inextricably entangled with the issues of health care costs and quality, and that these three matters must be dealt with concurrently. Indeed, by dealing with all three together it may be possible to forge a consensus of payers, 32
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From page 33... ...
But as the decade of the 1970s progressed, the focus of health policy debate began to switch as health costs and the percentage of the gross national product (GNP) spent on health care spurted.
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From page 34... ...
In the public sector, we moved into this period with President Carter's proposed hospital expenditure caps and intense debate on the relative efficacies of competitive versus regulatory strategies for cost containment. With the Reagan years and the growth of the federal deficit, tax-financed national health insurance fell completely off the table as a viable approach, and in the 1980s federal health policy was largely budget-driven as we progressed through prospective payment, annual diagnosis-related group (DRG)
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From page 35... ...
It is starting off as a time in which the Congress, having manifestly failed to resolve the health care cost issues, is in its typical fashion leaving those issues on the table while once again starting down the potentially conflicting track of expanding health care financing. Proposals for public or private insurance coverage of long-term care and home care have flourished in Washington.
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From page 36... ...
Whereas in the early 1970s mandated benefits proposals were raised in a context of grow ing voluntary employer-sponsored and public program coverage and only moderate annual health care cost increases, now they are coming to the fore again but in a context of shrinking private and public coverage and rapidly rising costs. The natural reaction to benefits mandates from the employer community is, for the most part, one of incredulity -- how can you even think of mandating our participation in a runaway system?
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From page 37... ...
First, a philosophical point. In the words of the Rosenthal Lecture, our goal should be a system that provides universal and affordable health care to all the American people.
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From page 38... ...
Code now protects any health care provider from civil liability on account of action taken in compliance with "professionally developed norms of care and treatment" applied by a PRO, provided that he or she uses due care. As practice guidelines become available from academic medical centers or broad-based provider organizations, HCFA might adopt those guidelines for use in connection with Medicare and the PROs.
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From page 39... ...
would have access to the pool, which ideally would be administered by a private carrier acting as a fiscal intermediary. Rates for the pools would be capped at, say, 110 percent of the average small case rate prevailing in that state for non-pool business, with any pool deficits made up by health insurance surtaxes levied on all employers.
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From page 40... ...
If an employer's plan met the federal minimum, he or she might get at least the following protections and benefits: a pre-emption of the 700 different benefit mandates now in place at the state level plus preemption of any specific federal benefit mandates; access to the provider rates paid by HCFA under the Medicare program; and the limited malpractice protection for the employer and his or her agents and providers described above, to the extent that he or she used HCFAendorsed practice guidelines in the management of his or her program. A brief word about each of these proposals.
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From page 41... ...
We should seek not a national health insurance bill, but a universal, affordable health care program in which payers, providers, and consumers will all see tangible benefits. I believe that such an approach, which strongly encourages the spread of employer coverage, should be tried before we move to any system of mandates.
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