Affordable, High-Quality Health Coverage for All through Shared Responsibility
November 26, 2007by Ron Pollack
The achievement of affordable, high-quality health coverage for everyone in the United States is only likely to happen if it is promoted as a matter of “shared responsibility” among the key stakeholders in America’s health care system. Such shared responsibility must meaningfully involve insurers, health care providers, employers, the public sector, and individuals and families. These responsibilities include, but are not limited to, the following.
With respect to insurers, we need to make sure that they do not discriminate in the provision of health care coverage. Too often, insurance companies are unwilling to provide health coverage for people who have prior illnesses, chronic conditions, or disabilities. Additionally, too large a portion of insurance premiums are devoted to expenditures that do not subsidize health care – expenditures for marketing and advertising, agents’ fees, administration, and profits. Thus, for insurance companies, shared responsibility includes providing health coverage on a non-discriminatory basis to people who need health care the most and limiting costs that are not directly related to the provision of health care.
For health care providers, we need to make sure they take all reasonable steps to ensure that highest-quality care is provided to their patients. This includes providing care that is consistent with the best science; cooperating in the development of information technology so that patients’ records can easily be accessed by other physicians and hospitals; taking the time to explain treatment options to their patients; avoiding conflicts of interest in health care referrals; and charging reasonable amounts for their services.
Employers also have an important role – and, indeed, they remain the predominant source of health care coverage in the private sector today. Unfortunately, the burden of paying for this coverage is expensive and increasingly unaffordable, and the burden is not shared equitably between different employers. The employers that provide health coverage are not only paying for the health care of their own workers, but they also wind up paying for the health care costs of uninsured workers whose employers do not provide health care coverage. If we retain an employer-based health care system (as appears likely and as many working families want), support needs to be provided to small businesses that have difficulty affording coverage and the burden of coverage for working families must be distributed more equitably.
The public sector also has important responsibilities. The public sector should provide an effective safety net for those who cannot secure coverage through their employment and who can’t afford to pay for health coverage on their own. For lower-income populations, this means an effective set of programs like Medicaid and the State Children’s Health Insurance Program (SCHIP), and, for more moderate-income populations, the provision of support – either through direct subsidies or substantial, refundable tax credits – that make the purchase of health coverage affordable. The public sector should also create and enforce rules ensuring that insurance companies provide health coverage without discriminating against people who have pre-existing conditions; support needed research to discover remedies for serious diseases; facilitate the development and proliferation of health information technology; and catalyze analyses of alternative health services and care to promote higher-quality and more cost-effective health care.
With respect to individuals and families, part of their responsibility is to live healthier lifestyles – eating properly, refraining from smoking and excessive alcohol, exercising, wearing seat belts, and obtaining appropriate, preventive care. For those who truly can afford health care coverage, it makes sense to require them to obtain such coverage. Failure to do so will leave many millions without health coverage. Such a failure will also increase the insurance premiums through inequitable cost shifts for those who already have health coverage; will significantly reduce the likelihood that insurance companies sell coverage to everyone; will continue to burden overcrowded emergency rooms; and will make it unlikely that many people secure timely preventive and primary care.
This shared responsibility not only makes abundant substantive sense, it will also foster cooperation among America’s health care stakeholders in remedying the growing health cost and coverage crisis. It deserves everyone’s support.
Contact Families USA for sources and additional materials.
Families USA, 1201 New York Avenue, Suite 1100, Washington, DC 20005
Phone: 202-628-3030 E-mail:
info@familiesusa.org
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