Universal health insurance through incentives reform

Article Abstract:

The American system of health care financing and delivery is deteriorating. The causes of the problem are complex, and reform must emphasize the most important and correctable aspects. Among the major reasons for rising health care costs is that the system provides more incentives to spend than to avoid spending. The fee- for-service (FFS) system pays more for doing more, with no budget for how much a job should cost, and there is no price competition. Health maintenance organizations (HMOs) are cheaper, but often employers do not offer this alternative or pay more for FFS. A second problem is that the present system encourages specialists to exercise their specialties, not to produce acceptable outcomes at a reasonable cost. A better system would gather data on outcomes, treatments and resource use upon which to base clinical decisions. The current system pays more to poor physicians who have high rates of complications (and therefore more procedures and tests), while high-quality physicians are unrecognized and unrewarded. There are too many hospital beds, and too many specialists compared with primary care physicians. Third, insurance companies profit by excluding those who need them most. Finally, public funds are not distributed equitably or effectively. To ensure health care access for all, comprehensive reform of economic incentives and managed competition are proposed, including the Public Sponsor (a quasi-public agency) to equalize health access, mandated employer-provided health insurance, contributions from employers and employees, a limit on tax-free employer contributions, no increase in government spending, managed competition in the insurance industry, and quality control linking outcomes and effectiveness. This type of comprehensive reform is preferable to the imposition of direct government controls. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medical care, Demographic aspects

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A framework for reform of the US health care financing and provision system

Article Abstract:

The Kansas Employer Coalition on Health, Inc, representing 100 businesses in the state, addresses issues such as spiraling health care costs, access and quality, and morbidity and mortality statistics. The coalition has compiled a list of principles and recommendations for health reform, including rights and responsibilities of individuals. People are responsible for buying insurance in accordance with their means, and for sharing in the cost of medical care. Each patient with the means should pay some fee for every episode of care, up to a predetermined maximum. Employers should sponsor health plans or pay a tax to support a publicly-funded plan. All health care plans must be required to accept any applying employer group or association of employer groups. The public has the responsibility to ensure that basic health care is available to all, regardless of ability to pay. The state or federal government should determine a single maximum annual percentage of premium increase for all health insurance plans, based on the consumer price index. A separate pool could be set up for catastrophes and epidemics. The insurance should spread risk over a wide base, and not burden any individual or group disproportionately. Community ratings should be the basis for determining premiums. The government should provide leadership for reform on the national, state and local level, including improved health education. Government monitoring will ensure quality of care. Reforms should be consistent with the current structure of the health care system, and should minimize regulatory controls as much as possible while controlling costs and assuring access and quality of care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social policy, Medicaid, Kansas

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The 'USHealth Act': comprehensive reform for a caring America

Article Abstract:

There is great need for change in the health care problems of the uninsured and the underinsured. The Pepper Commission was a good compromise, but the ''USHealth Act,'' which offers catastrophic and basic health protection to all Americans, is a more effective and affordable plan. The USHealth Administration would replace the Health Care Financing Administration, and consolidate Medicare, Medicaid, and private insurance into one insurance system. This system would be funded by cost sharing, employer contributions, state revenues, federal excise and income taxes, and beneficiary premiums. Cost containment is an important aspect of the program, and payment would be based on diagnostic related groups (DRGs) and resource-based relative value scales (RBRVSs), indexed to the per capita GNP. A broad range of preventive, and short- and long-term care services would be covered. The current Medicare quality assurance system would be extended and upgraded, evolving as the ability to evaluate quality of care improves. The criteria for a comprehensive solution are outlined, and the USHealth program meets all of them. The Pepper Commission proposal meets most of the criteria, and also deserves consideration. The remaining question is whether or not there is a commitment to carry out a health care solution. (Consumer Summary produced by Reliance Medical Information, Inc.)

Canada, Services, Medicare

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