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Health Policy Reform: Beyond the 2008 Elections



This publication ran as a supplement to the March/April 2008 issue of the Columbia Journalism Review.


With the 2008 presidential election in full swing, health care reform has jumped to the top of the nation's domestic policy priorities–and with good reason. Growing evidence indicates that the U.S. system falls short in critical areas. The number of Americans without health insurance is climbing steadily: 47 million people were uninsured in 2006, an increase of 8.6 million–more than 18 percent–since 2000. In addition, an estimated 16 million Americans are underinsured and paying high out-of-pocket costs for their care. Even people with good insurance coverage are feeling the effects of higher out-of-pocket health care costs, which are causing them to cut back on their retirement saving contributions. Meanwhile, the quality of care is highly variable and delivery of care is often poorly coordinated, driving up costs and putting patients at risk. In short, our health system is failing to perform as it should. With rising costs straining family, business, and public budgets, access deteriorating, and quality variable, improving health care performance is a matter of national urgency.

Recognizing the need for national leadership to revamp, revitalize, and retool the U.S. health care system, The Commonwealth Fund in 2005 established the Commission on a High Performance Health System, with the charge of promoting a high-performing health system. The Commission defines a high performance health system as one that helps everyone, to the extent possible, lead longer, healthier, and more productive lives. To achieve such a system, four core goals must be met:

  • Access to care for all
  • Safe, high-quality care
  • Efficient, high-value care
  • Continuous innovation and improvement

The Commission's work indicates that expanding access to health insurance coverage is the single most important step to achieving a better system. Presidential candidates from both the Democratic and Republican parties have proposed plans that seek to expand health coverage, albeit in different ways. And although increasing coverage is critical to improving health system performance, research points to a number of other policy steps that need to happen, from speeding the adoption of emerging information technologies that can enhance health care effectiveness and efficiency to building new payment mechanisms that reward quality of care instead of quantity.

This report draws on the Commission's work during the past three years, as well as other research, to provide journalists with an evidence-based context for understanding the fundamental problems plaguing our current health system, as well as policy options under consideration for addressing these problems. Regardless of the election outcomes in November, health reform will be among the most pressing domestic issues facing our nation's leaders. No one imagines that the problems described in this report will be solved quickly or easily, but there is no questioning their urgency.