Key Questions When Designing Universal Coverage

A major culprit in the inconsistent performance of the U.S. health care system is its failure to provide health insurance to 45 million people, as well as adequate financial protection to an additional 16 million adults who are "underinsured," said Commonwealth Fund assistant vice president Sara Collins, Ph.D., in invited testimony before the Senate Budget Committee on June 26.

Speaking at a hearing on health care reform options and the budget, Collins argued that universal coverage is essential to placing the U.S. health system on a path to high performance. She cited the billions of dollars in uncompensated care costs that are now picked up by federal, state, and local governments and other payers as a major obstacle to achieving greater health system efficiency.

How universal coverage is designed "will matter greatly," Collins said, to ensure that all children and adults receive "the right care, at the right time, and in the right setting over their lifespan." Collins provided lawmakers with some key questions to ask when evaluating various health reform proposals:

• Does the proposal improve access to care, both for people without any health insurance and for those with inadequate coverage?
• Will it lower growth in health care costs while improving efficiency in the health system?
• Does it make the health system more equitable—for example, by improving access to good-quality, affordable care for people in all income groups?
• Does it contain incentives and other provisions to spur continuous quality improvement?

While universal coverage, if carefully designed, can reduce total health spending, it is likely to increase federal budget outlays. But Collins says that federal cost has to be considered in context. "We can only move forward when we keep our eye on the number that really matters: the $2 trillion that we spend as a nation on health care each year."