A call for action: the Pepper Commission's blueprint for health care reform

Article Abstract:

Many workers who once had good health insurance coverage face the loss of that coverage when they need it the most. Small and medium-sized businesses often find they cannot get insurance coverage. Meanwhile, large businesses face the problem of spiraling costs. In 1965 health care spending amounted to about 14 percent of after-tax profits; in 1984 it was 74 percent, and by 1987, it was 94 percent. Such enormous increases naturally raise questions about value obtained for the health care dollar spent. The United States exceeds other nations in per capita spending on health, but lags behind other industrialized nations, and many poorer ones, in mortality statistics, especially infant deaths. The US Bipartisan Commission on Comprehensive Health care, known as the Pepper Commission, has designed a system to reform health care. The basic assumptions are that health insurance must be universal, patchwork reform of Medicaid and other programs will not be effective, a national health insurance system is too disruptive at this time, and expansion of access and control of costs must be considered together. The commission has outlined a plan for coverage of job-based insurance, with separate policies for small and large businesses. The government must guarantee affordable coverage, perhaps through Medicare. Medicaid should be replaced with a new program for nonworkers and the self-employed. Minimum benefits must be defined, and quality and cost containment must be ensured. Such a program is desperately needed by many Americans, but it must be implemented incrementally, probably over a five-year period. The increased cost of the program envisioned is relatively small, and would be shared among individuals, employers, and the government. Employers, individuals, and state and local governments would actually save money because coverage would not be duplicated for dependents, and the cost of uncompensated care of the uninsured would be avoided. Federal costs are to be covered by progressive taxes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Laws, regulations and rules, Finance, Reports, Statistics, Health insurance, National health insurance, United States. Bipartisan Commission on Comprehensive Health Care

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The first step

Article Abstract:

Implementing universal health care coverage may be the first step towards the provision of affordable, portable, and secure health insurance. Many people erroneously believe that health care reform in 1995 must be achieved in incremental steps. These types of reforms would target the insurance industry and would provide subsidies to help people with low incomes afford health insurance. This approach will cause health care costs to rise until health insurance becomes unaffordable. Subsidies financed through deficit reduction may fluctuate yearly and may be inadequate to purchase health insurance. Furthermore, incremental reforms do not address direct cost containment. Universal coverage in concert with specific cost control strategies will increase coverage, preserve choice of medical providers, and maintain affordability. Policymakers must inform the public that the health care system in 1995 already incorporates the costs of providing medical care to the uninsured. The costs of universal coverage are nominal compared to consequences of incremental reform.

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Moving ahead with health care system reform

Article Abstract:

Modest health system reforms that target the insurance industry, broaden coverage for at-risk populations, and facilitate reform at the state level may help control health care costs and demonstrate the value of legislative reforms to the public. Insurance reform that prohibits the assessment of widely varying premiums based on sex, occupation, or health status will help stabilize rates and reinstate predictability. Modifications to the Employee Retirement Income Security Act (ERISA), which exempts self-insured employers from state insurance laws, may help strike a compromise between state-led health care reform and employers' needs for uniformity. Children, pregnant women, and the poor should receive expanded health care coverage. Proposals to reduce Medicare and Medicaid spending as deficit reduction measures can only be effective if the number of insured people increases.

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