Framework for a new health system

[HM2VikingRN, RN]

We cannot solve the health care crisis by simply giving everyone insurance coverage (i.e. this is not just an insurance problem).

We are all in this together and have challenged the whole concept of "categorical eligibility."

All Americans should be eligible for and have timely access to effective treatment for at least the same set of essential health conditions ("core benefit")

The core benefit should be portable and not tied to employment.

In terms of financing, we believe the first emphasis should be on the public resources already being spent on health care. We are not trying to dictate what people do with their private after-tax dollars, but rather to ensure that public resources are spent in a way that is equitable, efficient and effective in producing health.

Market competition should be based on cost, quality and outcomes, not the avoidance of risk.

We must explicitly recognize the reality of fiscal limits and that we cannot purchase everything for everyone.

We must acknowledge the inevitability of at least a two-tiered system; that people with more disposable income will always be able to purchase more than people with fewer resources. People should be able to purchase additional services that may not be covered in the core benefit. The challenge is to ensure that the core benefit (the "floor") is adequate to provide for the health of all Americans.

All medical interventions are not of equal value and effectiveness in producing health, and therefore a prioritization process must be established to decide what will be financed with the public resources.

Individuals should be more directly involved in their own health care treatment decisions.

It is important to promote healthy behaviors through strategies that focus on both individual choices (responsibility) and environmental influences.

Co-payments should be used not simply to shift costs to individuals, but rather to influence individual behavior by placing lower co-payments (or no co-payments) for highly effective procedures backed by good scientific evidence and higher co-payments on lower priority interventions.

at http://wecandobetter.org/framework-for-a-new-health-system

[Katie82, RN]

I agree with this 100%. It is the only way a UHC system would work. As someone who works with the Medicaid population, I would like to see these principles applied to that system. One of my biggest issues with Medicaid is that the coverage my patients receive is much more inclusive than the coverage I pay for privately. The issue with this, of course, is that few politicians want to be seen as being restrictive to the "less fortunate" population. A perfect example is the SCHIP legislation that recently passed. IMHO, middle class folks should be responsible for paying for their children's health insurance. For many of these newly covered families, the premium they should be paying will be the difference between a mid-priced sedan and a land-yacht sized SUV sitting in the driveway of a home they can barely afford.

[HM2VikingRN, RN]

The reality is that we need to spend more on preventive care and less on cure going forward into the future. Medicaid/SCHIP are mandated to provide a coverage level similar to that of good private insurance plans. My personal belief is that we spend plenty of money for administration and not nearly enough on preventive care. What we spend on administration could be used to improve coverage levels for all americans.

Middle class means different things depending on where you live in the US. A minimal middle class income in MPLS is around 60,000/year for a family of 4. In NY its closer to 80,000. (EPI.org has extensive discussions about family budget that are enlightening to say the least.)