Check a new related video editorial by Karen Davis, "The Time Is Right for Healthcare Reform," on Medscape.
Change has come to the U.S. Congress, and with it the likelihood that health policy issues will move to the legislative front burner. Many candidates from both parties made health care a highlight of their campaigns and their subsequent acceptance speeches; they knew their constituents were interested. A recent Commonwealth Fund survey showed that three-quarters of all adults believe the U.S. health care system needs either fundamental change or complete rebuilding. The public's top health policy priorities? Ensuring that all Americans have adequate, reliable health insurance; reining in rising medical costs; and lowering the cost of prescription drugs.
Tackling High Numbers of Uninsured, Costs
None of this is very surprising given that the high number of uninsured Americans, coupled with rising health care costs, have brought our health care system to a near-breaking point. The number of uninsured in the U.S. has risen at a remarkable rate, growing from 40 million in 2000 to 47 million in 2005. Meanwhile, the U.S. spends twice what other countries spend per capita on health care, and employer family health insurance premiums have risen 81 percent since 2000, while the median family income has increased by only 11 percent.
If a new Congress takes a truly bipartisan approach to health care, the country could begin to attack these trends. Democrats in key positions are likely to prioritize better coverage for children and working families, as well as lower prescription drug prices. And they may find common ground with Republican members—especially those from states bordering Canada, where residents are acutely aware of the availability of cheaper medications outside the U.S. There is already some innovation occurring across states to address the needs of the middle- and lower-income adults and their families who find they can't afford to get sick, even when insured, due to rising out-of-pocket costs.
Federal policies could build on and enhance those efforts. The pending reauthorization of the State Children's Health Insurance Program this year should focus attention on enhancing coverage and making sure that all children get off to a healthy start in life; priorities include ensuring adequate funding, setting quality standards, and perhaps expanding coverage to additional low-income children and their parents.
Innovations such as Massachusetts's health insurance "connector" provide a model for helping small businesses, as well as the self-employed and other individuals, obtain stable coverage and a choice of plans, and reap the benefit of being part of a large group. Coverage rates could be further improved with assistance from the federal government with paying premiums for low-wage workers to ensure affordability. The federal government could also assist with strategies to offset some of the cost for employers with aging workforces, whose higher costs for health benefits are undermining the employers' competitiveness.
To help address the burden of high prescription drug costs, Congress may turn to legislation granting Medicare the authority to negotiate drug prices that are similar to those paid by the Veterans' Administration, and to eliminate the surplus payments Medicare managed care plans currently receive from the government. Congress can then use these savings to reduce or eliminate Medicare's prescription drug coverage gap, or "doughnut hole."
Encouraging IT and High Provider Performance
Legislation designed to further the adoption of information technology (IT) across the health care system now has a greater chance of passage, as well. The spread of the use of IT is a key strategy for improving quality and efficiency in the U.S. health care system. We need such a bill to help the U.S. keep up with developments in IT that are already helping other nations offer high-quality, more-coordinated, patient-centered care. According to a recent Commonwealth Fund survey, only 28 percent of U.S. doctors said they used electronic medical records, compared with overwhelming majorities of doctors in the Netherlands, New Zealand, the U.K., and Australia.
Finally, Congress may work toward establishing a pay-for-performance Medicare payment system for health care providers that would financially reward high-quality patient-centered care, and efficiency. Congress should also call for greater public reporting of quality and total costs of care for a given condition—and encourage steps the Administration has already made in this direction.
A Changing State—and National—Landscape
The landscape has changed in statehouses as well, and new governors may make their marks on local efforts to improve quality of care and coverage. State-specific efforts, such as those already underway in Maine, Massachusetts, Rhode Island, and Vermont, could be facilitated by bipartisan federal legislation to provide federal funds to cover the uninsured, create health information exchanges, invest in primary care, and improve quality.
Continuing on our current course is unacceptable. The country has already taken its first steps toward significant federal and state support for a high-performing health system. But more progress is needed. The U.S. can learn from innovative examples—both within our borders and abroad—of effective policies and practices that lead to better health for everyone. If Democrats and Republicans are willing to commit to working together to achieve such reform, all Americans will benefit.
As always, I'm interested in your feedback—and in innovative state strategies you may want to share. Please e-mail me at [email protected].
Written with the assistance of Christine Haran, web editor.