The Audacity of Hope - Barack Obama [87]
In 1993, President Clinton took a stab at creating a system of universal coverage, but was stymied. Since then, the public debate has been deadlocked, with some on the right arguing for a strong dose of market discipline through Health Savings Accounts, others on the left arguing for a single-payer national health-care plan similar to those that exist in Europe and Canada, and experts across the political spectrum recommending a series of sensible but incremental reforms to the existing system.
It’s time we broke this impasse by acknowledging a few simple truths.
Given the amount of money we spend on health care (more per capita than any other nation), we should be able to provide basic coverage to every single American. But we can’t sustain current rates of health-care inflation every year; we have to contain costs for the entire system, including Medicare and Medicaid.
With Americans changing jobs more frequently, more likely to go through spells of unemployment, and more likely to work part-time or to be self-employed, health insurance can’t just run through employers anymore. It needs to be portable.
The market alone can’t solve our health-care woes—in part because the market has proven incapable of creating large enough insurance pools to keep costs to individuals affordable, in part because health care is not like other products or services (when your child gets sick, you don’t go shopping for the best bargain).
And finally, whatever reforms we implement should provide strong incentives for improved quality, prevention, and more efficient delivery of care.
With these principles in mind, let me offer just one example of what a serious health-care reform plan might look like. We could start by having a nonpartisan group like the National Academy of Science’s Institute of Medicine (IOM) determine what a basic, high-quality health-care plan should look like and how much it should cost. In designing this model plan, the IOM would examine which existing health-care programs deliver the best care in the most cost-effective manner. In particular, the model plan would emphasize coverage of primary care, prevention, catastrophic care, and the management of chronic conditions like asthma and diabetes. Overall, 20 percent of all patients account for 80 percent of the care, and if we can prevent diseases from occurring or manage their effects through simple interventions like making sure patients control their diets or take their medicines regularly, we can dramatically improve patient outcomes and save the system a great deal of money.
Next, we would allow anyone to purchase this model health-care plan either through an existing insurance pool like the one set up for federal employees, or through a series of new pools set up in every state. Private insurers like Blue Cross Blue Shield and Aetna would compete to provide coverage to participants in these pools, but whatever plan they offered would have to meet the criteria for high quality and cost controls set forth by IOM.
To further drive down costs, we would require that insurers and providers who participate in Medicare, Medicaid, or the new health plans have electronic claims, electronic records, and up-to-date patient error reporting systems—all of which would dramatically cut down on administrative costs, and the number of medical errors