The Recommendations

The following is from the preamble to the recommendations:

The health care system that captures vast amounts of America’s resources, employs many of its most talented citizens and promises to relieve the burdens of dread disease badly needs to be fixed. Health care costs strain individual, household, employer and public budgets. Often our citizens forego needed treatment because they are priced out of the market. At the same time, public budgets are buckling under the burden of public health care programs.

We spend nearly $2 trillion on health care each year, yet geography, race, ethnicity, language and money impede Americans from getting appropriate care when they need it. People in Utah recently spoke for tens of millions of Americans when they noted

“[the] inability to navigate the health care system without luck, a relationship, money and perseverance”.

Far too often sick Americans lack one or more of these factors needed to get health care.

• All Americans will have access to a set of core health care services across the continuum of care throughout the lifespan.

     o Access to care means that everyone should be able to get the right care at the right time and at the right place. Appropriate health care must be available and affordable, as well as convenient and accessible for people in their communities. People’s ability to get services and be treated appropriately and in a respectful manner are also essential aspects of access to care.

     o Health care encompasses wellness, preventive services, and treatment and management of health problems.

Interim Recommendations

􀂾 CORE BENEFITS: Americans will have access to a set of affordable and appropriate core health care services by the year 2012.

Recommendation 1:

It should be public policy that all Americans have affordable health care

All Americans will have access to a set of core health care services. Financial assistance will be available to those who need it.

Across every venue we explored, we heard a common message: Americans should have a health care system where everyone participates, regardless of their financial resources or health status, with benefits that are sufficiently comprehensive to provide access to appropriate, high-quality care without endangering individual or family financial security.

Financing Health Care that Works for All Americans

This and other of the recommendations contained here call for actions that will require new revenues to provide some health care security for Americans who are now at great risk. The opinion polls we examined, the community meetings we held, and the web based surveys and comments we received, all showed large majorities of people willing to make additional financial investments in the service of expanding the protection against the costs of illness and the expansion of access to quality care.

We recommend adopting financing strategies for these recommendations that are based on principles of fairness, efficiency, and shared responsibility. These strategies should draw on dedicated revenue streams such as enrollee contributions, income taxes or surcharges, “sin taxes”, business or payroll taxes, or value-added taxes that are targeted at supporting these new health care initiatives.

We note that improvements in efficiency through a variety of mechanisms such as investments in health information technology, public reporting, and quality improvement may be realized over time. To the extent that such efficiency gains are obtained they would be used to assist in paying for new protections such as those against catastrophic health care expenditures and the impoverishment of individuals as a result of getting the health care they need.

No specific health care financing mechanism is optimal. We understand that the transition from the current system to a system that includes all Americans will take time and that multiple financing sources will need to coexist during the move to universal coverage. However, the disparate parts must be brought together in a way that ensures a seamless and smooth transition.

Recommendation 2:

Define a “core” benefit package for all Americans

Establish an independent non-partisan private-public group to identify and update recommendations for what would be covered under high-cost protection and core benefits.

• Members will be appointed through a process defined in law that includes citizens representing a broad spectrum of the population including, but not limited to, patients, providers, and payers, and staffed by experts.

• Identification of high cost and core benefits will be made through an independent, fair, transparent and scientific process.

The set of core health services will go across the continuum of care throughout the lifespan.

• Health care encompasses wellness, preventive services, primary care, acute care, prescription drugs, patient education and treatment and management of health problems provided across a full range of inpatient and outpatient settings.

     o Health is defined to include physical, mental and dental health.

     o Core benefits will be specified by taking into account evidence-based science and expert consensus regarding the medical effectiveness of treatments.

􀂾 IMMEDIATE PROTECTION FOR THE MOST VULNERABLE: Action should be taken now to better protect Americans from the high costs of health care and to improve and expand access to health care services.

Recommendation 3:

Guarantee financial protection against very high health care costs

No one in America should be impoverished by health care costs.

Establish a national program (private or public) that ensures

• Coverage for all Americans,

• Protection against very high out-of-pocket medical costs for everyone, and

• Financial protection for low income individuals and families.

 Recommendation 4:

 Support integrated community health networks

The federal government will lead a national initiative to develop and expand integrated public/private community networks of health care providers aimed at providing vulnerable populations, including low income and uninsured people, and people living in rural and underserved areas, with a source of high quality coordinated health care by:

• Identifying within the federal government the unit with specific responsibility for coordinating all federal efforts that support the health care safety net;

• Establishing a public-private group at the national level that is responsible for advising the federal government on the nation’s health care safety net’s performance and funding streams, conducting research on safety net issues, and identifying and disseminating best practices on an ongoing basis;

• Expanding and modifying the Federally Qualified Health Center concept to accommodate other community-based health centers and practices serving vulnerable populations; and

• Providing federal support for the development of integrated community health networks to strengthen the health care infrastructure at the local level, with a focus on populations and localities where improved access to quality care is most needed.

􀂾 QUALITY AND EFFICIENCY: Intensified efforts are central to the successful transformation of health care in America.

Recommendation 5:

Promote efforts to improve quality of care and efficiency

The Federal government will expand and accelerate its use of the resources of its public programs for advancing the development and implementation of strategies to improve quality and efficiency while controlling costs across the entire health care system.

• Using federally-funded health programs such as Medicare, Medicaid, Community Health Centers, TRICARE, and the Veterans’ Health Administration, the federal government will promote:

     o Integrated health care systems built around evidence-based best practices;

     o Health information technologies and electronic medical record systems with special emphasis on their implementation in teaching hospitals and clinics where medical residents are trained and who work with underserved and uninsured populations;

     o Reduction of fraud and waste in administration and clinical practice;

     o Consumer-usable information about health care services that includes information on prices, cost-sharing, quality and efficiency, and benefits; and

     o Health education, patient-provider communication, and patient-centered care, disease prevention, and health promotion.

Recommendation 6:

Fundamentally restructure the way that palliative care, hospice care and other end-of-life services are financed and provided, so that people living with advanced incurable conditions have increased access to these services in the environment they choose

Individuals nearing the end of life and their families need support from the health care system to understand their health care options, make their choices about care delivery known, and have those choices honored.

• Public and private payers should integrate evidence based science, expert consensus, and culturally sensitive end of life care models so that health services and community-based care can better deal with the clinical realities and actual needs of chronically and seriously ill patients of any age and their families.

• Public and private programs should support training for health professionals to emphasize proactive, individualized care planning and clear communication between providers, patients and their families.

• At the community level, funding should be made available for support services to assist individuals and families in accessing the kind of care they want for last days.