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Health Experts Discuss Ways to Achieve Universal Health Coverage

By Lauren Phillips, CQ Staff

July 20, 2007 – Health care experts came together this week to unveil four different policy proposals aimed at the same goal: launching a universal health care coverage system in the United States.

The authors agreed that universal health care is the next step in the health care debate. Among the principles of their policies, they said, is a focus on involving the lowest-income population who are uninsured. It is estimated that 45 million Americans are uninsured, and those who are insured spend more than one-sixth of their income on health care.

Tuesday's event was hosted by the Brookings Institution's Hamilton Project, which aims to develop economic strategies and policy ideas to promote growth.

"Universal health care is the broadest step we can take to protect the economic security of the American family," said Robert E. Rubin, chairman of the Executive Committee at Citigroup Inc. and former Treasury Secretary. "The first step is covering the uninsured," said Rubin, a member of the Hamilton Project Advisory Council.

One proposal, co-authored by Ezekiel Emanuel of the National Institutes of Health, suggested initiating a government voucher system, instead of current insurance programs, that would provide a standard package of benefits comparable to employer-given health insurance.

Another plan, drafted by The Heritage Foundation's Stuart Butler, would create a "Health Exchange Plan," which would evolve the current system to allow for portable insurance through state-charted "insurance exchanges. It also would overhaul current tax subsidies to target lower-income families.

"There is a fear of change among Americans," Butler said. "It's far better to make minimal changes to those parts of the system that work tolerably well, such as the large employment-based systems, and then construct mechanisms that are familiar to people who do not have coverage and allow others to gradually opt in to them."

Members of a different panel tasked with discussing how the plans could be implemented in the real world praised components of each strategy, but agreed that none was "perfect" yet.

Former Centers for Medicare and Medicaid Services Administrator Mark B. McClellan, one panelist, said the solution would start with incremental changes that would offer choices to people in how they get coverage. The first step would likely be state overhauls, said McClellan, currently a Brookings visiting fellow.

Gerard Anderson, a professor at the Johns Hopkins Bloomberg School of Public Health, suggested expanding Medicare to allow everyone to enroll if they choose. His plan, which he co-authored, would require people to have health insurance, and require employers to provide it. It would allow firms and individuals to retain their current private insurance.

That plan might be one that unions and their members would likely accept, or another plan where the government or public has the bottom line, said panelist Gerald W. McEntee, international president of the American Federation of State, County and Municipal Employees. He said the first step toward that goal would be opening Medicare coverage to people older than 55 and expanding the State Children's Health Insurance Plan (SCHIP).

Expanding SCHIP is critical to implementing a universal health care system, said Former Treasury Secretary Lawrence H. Summers, a Hamilton Project Advisory Council member. Summers also sat on the discussion panel.

A proposal co-authored by Jonathan Gruber of the Massachusetts Institute of Technology would make the Massachusetts health care system national. The state law requires all residents to obtain health insurance. It provides subsidies to those with lower incomes to help them pay for that coverage. And it creates a state-run marketplace called "the Connector" to help individuals and employees of small businesses find affordable health plans.

Another panel member, General Mills Chairman and CEO Stephen W. Sanger, said he liked Gruber's proposal, but said he favors proposals that focus on the role of the physician and the user, and that take market forces into consideration. The first step toward a health insurance solution, Sanger said, would be to move more conceptually and expand large employer programs that already treat employees.

Summers said it is "inconceivable" to build a health care plan that resembles the current system, and agreed that change had to come little by little.

"Everything in my training says to me that before you think about a system, you should spend at least a little bit of time saying, if the whole thing were on a piece of paper, how would we draw this, and at least try to understand the answer to that question before you set a course," Summers said. "I think it's inconceivable that you'd start any system with any resemblance to our system."

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