Health Care Reforms Americans Want

It's rare that Americans speak up and speak clearly about what we want, and that Washington has in hand a plan that delivers it. In its latest issue, Consumer Reports has published some survey results that spell out six health care reforms the majority of Americans want [1]. It just happens that—while it hasn't been implemented yet—Health Care for America [2], authored by Professor Jacob Hacker [3], includes all six reforms.

In November 2007, 1200 Americans age 18 and older responded to a Consumer Reports telephone poll. More than 80% of them said that any health care reform should include six items. Let's take a look at them one by one, and compare them to Health Care for America [2].

Coverage for all uninsured children.

Right from the start, Health Care for America would provide coverage for all children.

It would extend insurance to all non-elderly Americans...

So, there would be no children in America without health insurance. The impact of that change alone has implications in several areas. Education is definitely one. Back in November, at the time of the Consumer Reports survey, there were reports that the growing number of uninsured children make it harder for educators to focus on achievement [4], because they first have to address the needs of students without health insurance.

Instead of notifying parents when their children are ill, school officials increasingly must help find health care, arrange transportation for sick children and often advise beleaguered parents about the health consequences of their inaction.

Schools that don't accept the extra responsibility can lose those students to prolonged absences that jeopardize their academic advancement.

...The number of uninsured children age 18 and younger grew by 710,000 to a total of 9.4 million in 2006, according to new research by the Urban Institute. Seventy percent of these newly uninsured children came from families earning more than twice the federal poverty level — that's $41,300 for a family of four.

More than 3 million of these uninsured youngsters would get full health insurance under legislation Congress passed to renew and expand the State Children's Health Insurance Program by $35 billion over five years. About 6.6 million children are now covered under the program.

That legislation was twice vetoed by the "education president," but let's move on.

Protection against financial ruin due to a major illness or accident.

Right now, if you have a major illness or accident, you're either on your own or at the mercy of insurance companies that may not help, and might just take the opportunity to revoke your coverage. As the saying goes "You pays your money, and you takes your chances." Health Care for America would protect Americans against financial ruin due to health problems by applying the time tested principle of shared risk to control health care costs.

At heart, it rests on the time-tested idea of social insurance, the notion that major financial risks should be pooled as widely as possible across rich and poor, healthy and sick, young and old. Health Care for America would create a large publicly overseen insurance pool that would bargain for lower prices, capitalize on the vast administrative efficiencies of a single insurer, and use its reach and purchasing power to spearhead improvements in the quality and cost-effectiveness of medical care.

That would come in particularly hand for families who are dealing with chronic illness and bumping up against insurance caps [5], and we're not even done yet.

The ability to obtain coverage regardless of a pre-existing condition.

Again, the answer comes directly from Health Care for America.

If one word captures the essence of Health Care for America, it is “guaranteed.” Health Care for America would guarantee coverage;

Here again, Health Care for America guarantees coverage, which not only protect those with pre-existing conditions, but those who may be genetically predisposed to some conditions. Right now, the state of our health care system is such that some Americans are deciding not to have DNA tests done [6], or paying for the tests themselves and keeping the results secret, because they fear being denied insurance or having their insurance terminated if their insurers know that they even had tests done. In some cases, people worry that they might be denied jobs if their genetic predisposition or susceptibility somehow becomes known.

Those worries are not entirely unfounded either. A California woman was recently awarded $9 million [7] in a suit against her former insurer, after the company canceled her coverage as she was undergoing treatment for breast cancer in 2004, leaving her with $129,000 in medical bills. In fact, discovery in this case revealed that the insurance company awarded bonuses based on how many policyholders were dropped [8]—usually after major medical claims were made, leaving sick patients with huge medical bills—and how much money the insurer was saved.

Now, what about health insurance that's linked to employment?

Coverage that continues even when people are laid off, changing jobs, or starting their own business.

Most of us who have health insurance are covered by our employers. That means no more coverage when we leave the job (or the job leaves us). In an economy that's losing jobs [9]—one in which more jobs are in jeopardy [10], and the unemployed are spending more time looking for job and not finding them [11]—it's natural that people worry about losing their jobs and losing their health insurance.

Health Care for America answers that concern too.

In sum, every American with a direct or family tie to the workforce—a group that includes more than 80% of the currently uninsured and more than 90% of all non-elderly Americans—would be automatically covered by either private insurance or the Health Care for America Plan.

So, if you're covered under Health Care for America and you lose your job, your still covered. If you have insurance through your job and you lose your job, you can still be covered under Health Care for America.

What if you have private coverage that you like and want to keep? You can.

The ability of people to keep their current health insurance if they choose.

Health Care for America does not eliminate private coverage, either employer-provided or consumer-purchased. No one who has coverage they want to keep would have to part with it, and many would get coverage who were without it before. As the quote above states, most Americans "would be automatically covered by either private insurance or the Health Care for America Plan."

Finally, people are concerned about the rising cost of health care. Some of us who are dealing with chronic illness , ourselves or in our families, are quickly reaching lifetime benefit caps [5]. Some of us are turning to credit, and borrowing against home value or equity to pay health care costs. Some hospitals and other health care providers are turning medical bills into consumer debt [12], with double-digit interest rates. Some of us are hit by high out-of-network costs [13] that we're surprised to find our insurers don't cover to the extent we thought.

Premiums, deductibles, and out-of- pocket expenses that are affordable relative to family income.

Health Care for America bases premiums on income, and provides assistance to help people afford coverage.

Premiums would again be based on income, ranging from no premium in the case of those with incomes below the poverty line to the average actuarial cost of coverage for all enrollees in Health Care for America in the case of those with incomes above 400% of the poverty level.

What's more, Health Care for America would means savings [14] for both the federal government and consumers—a total of $1 trillion in 10 years—and join with Medicare to bargain for lower prices while increasing the quality of care.

I don't remember where I heard it, but when I hear it said that, "Freedom and liberty are meaningless without two things; knowledge of them and the ability to act on them," I adopted it as part of my own philosophy. To me, health care is a requirement for having the "ability to act," and to embark on the "pursuit of happiness."

We have a chance, in the near future, to remove a major obstacle to the "pursuit of happiness" by providing health care to most Americans. It's what most Americans want. And it's clearly something we can do. If we are to be the country we say we are in our founding documents, it's also something we must do.