Candidates' Health Proposals Must Be Bolder, Panel Says

By John Reichard, CQ HealthBeat Editor

November 15, 2007 -- A panel of experts on the elements needed to create a "high performance" U.S. health system said Thursday that current proposals by presidential candidates are not daring enough. Those proposals must go beyond creating universal coverage to include various measures to improve the quality and efficiency of the system, said the report released by the Commonwealth Fund Commission on a High Performance Health System.

The report said candidates should measure their plans against these standards:

• Affordable health coverage should be extended to all Americans in a way that maintains their health care benefits when they change jobs, become a widow or a widower, or become ill.
• The current fee-for-service payment system should move to a model where doctors and hospitals "share the accountability for the total care of their patients." In addition, the payment gap between primary care and specialty care physicians should be narrowed.
• Doctor, hospital, and other health care services should be linked together to better coordinate treatment and to make it easier for patients to go from a primary care doctor to a specialist or hospital or other types of services.
• Investments should be made in health information technology to make care more efficient and of a higher quality, including by promoting "evidence-based medicine."
• The creation should be explored of a national body to set goals for the health system, develop performance measures, and recommend ways to achieve them.

The report lays out "why and how we need to go beyond coverage," Commonwealth Fund President Karen Davis said Thursday at a Washington luncheon to release the findings. "It's absolutely clear we don't get value for our health care dollar." The arrival of a new administration in 2009 "affords an historic opportunity to transform our health system," she said.

The commission plans other steps in coming months to influence health care proposals in the presidential campaign. In December it will release a report analyzing the pros and cons of various ways to control health care costs. In January it will release an analysis of how the candidates' plans stack up against the benchmarks announced by the commission. And next spring it will release an analysis comparing presidential proposals in terms of how much they cost and how many people they would cover. Reports also are planned in May on what must be done locally and in the fall on what must be done nationally to organize a high performance system.

Commission members said at the luncheon that they've made visits around the country to identify efficient ways to deliver care, including to Minneapolis and to California to meet with executives of the Kaiser Permanente health plan. The aim is to showcase ways to improve the system without running up costs. Another visit to North Dakota showed there are ways to organize effective care in areas where health care resources are limited, said commission member Mary K. Wakefield. Wakefield is a former member of the Medicare Payment Advisory Commission and is currently a researcher at the Center for Rural Health at the University of North Dakota.