"Covering the Uninsured" - Strengthening employer-based coverage?
(Although this message is quite long, it is important. The Covering the Uninsured campaign is designed to end with comprehensive reform of our health care system. It has a real possibility of being successful. We should be aware of their agenda and be involved in the process. The future of our health care system may depend on it.)
CoveringTheUninsured.org A project of the Robert Wood Johnson Foundation http://coveringtheuninsured.org/
Covering the Uninsured is a campaign to "raise awareness of the challenges facing the 39 million Americans with no health insurance." In addition to the Robert Wood Johnson Foundation, coalition members for the campaign include the U.S. Chamber of Commerce, AFL-CIO, The Business Roundtable, Service Employees International Union, American Medical Association, American Nurses Association, Health Insurance Association of America, Families USA, American Hospital Association, Federation of American Hospitals, Catholic Health Association of the United States, and AARP.
This is a very important campaign. It may set the stage for the future of health care in the United States. The initial phase of the campaign is to establish an awareness amongst the public that reform is absolutely essential. Theoretically, options for reform then will be presented and the nation will decide on the policies that we wish to follow. But, in fact, it may be that the agenda for reform is already established and this campaign is merely to gain acceptance of the policies that will best serve some of the special interests in the coalition.
Cover the Uninsured Week will be held beginning Monday, March 10, 2003. The goals will be to "raise public awareness of the problem... demonstrate broad support for action... generate significant media attention... encourage other national organizations to join... foster cooperation... and link multiple coverage initiatives with a single rallying point..." With diverse views on options for reform or "multiple coverage initiatives," we should ask what "single rallying point" they have in mind.
Let's look at the events of Covering the Uninsured Week. They will take place nationally and also with a focus on 25 cities.
Monday, March 10 - Town Hall Meetings Politicians of all levels will hold town hall meetings and media events and issue proclamations in a high profile effort to publicize the plight of the uninsured.
Tuesday, March 11 - On Campus Schools for health professionals and other colleges will hold academic events to raise awareness and to begin to look for solutions for the problems of the uninsured.
Wednesday, March 12 - Health Fairs Free health screenings will be provided with press conferences stressing that the uninsured should have access to health care everyday.
Thursday, March 13 - Business & Labor Day The full events of the day are presented below.
Friday thru Sunday March 14-16 - Interfaith Events The faith community will raise their voices in support of "health care as a fundamental human right," and "in many media markets, weekend services will represent the conclusion of the weeklong activities, and a special effort will be made to reach religion page reporters as well as local religious papers and magazines."
Days TBD - Arts & Culture "With the cooperation of arts communities, we will discuss the issue of the uninsured using art that people enjoy in their daily lives, including outdoor advertising, photographs, murals, television shows, newspaper cartoons, museum exhibits, etc."
Before we look at the events planned for Thursday, Business & Labor Day, we should review the press conference at the start of this campaign in February. The day began with an editorial in The Washington Post, written jointly by Thomas Donahue, President and CEO of the U.S. Chamber of Commerce and John Sweeney, President of the AFL-CIO calling for making "the problem of the uninsured our nation's top health priority and to help America solve it."
Representatives of each of the coalition organizations spoke briefly, and most of them stated that reform must be limited to incremental measures.
Then Thomas Donahue said, "The other thing we should know is that there are a lot of private conversations going amongst the people here. I mean, we didn't just show up here today to, you know, make a statement. We've been having a lot of conversation and I'm encouraged by it because it hasn't got the vitriolic kind of who shot Jack, you know. It's really-if this is the kind of problem-then how could we fix it and what ways might work."
And he also said, "If we move vigorously towards a single payer system which, by the way, doesn't work anywhere in the world, we're gonna find a great migration away from the people that are providing the coverage, and we can't afford that."
With this narrower agenda in mind, let's look at the activities planned for Thursday. Because of the subtleties, the entire concept page is reproduced here.
******************************* THURSDAY: COVER THE UNINSURED WEEK-BUSINESS & LABOR DAY
Concept These events will emphasize the interests of business and labor constituencies in expanding health coverage to the uninsured. They will highlight the joint interest of these constituencies in solving the problem, while allowing each to showcase their respective approaches. Since the rising cost of health care coverage is a growing concern of both business and labor groups, we will focus the event and messaging around health care coverage costs.
Day's themes/messages · Employers and employees share concern about the uninsured and strengthening employer-based coverage. · Health insurance means economic security for working families, yet eight out of 10 uninsured Americans are in working families.
Potential activities · Business and labor groups cosponsor press conferences at the local level, or hold them separately · Nationally and locally, organizers place an op-ed co-authored by business and labor leaders · Pitch editorial boards about the event and the issue · Events staged to emphasize the special needs of small business owners, possibly in conjunction with corporate partners who cater to small business needs (e.g., Staples, Kinkos, Costco, Home Depot, beauty supply stores, etc.) · Round table discussion/forum with local business leaders, labor leaders, and uninsured workers, hosted by local media affiliates (e.g., NPR), to discuss the issue in-depth · Round table discussion/forum on national business channel such as CNBC or CNN-FN · Conduct and release findings of a national survey of business and labor that demonstrate their shared concern about the issue of the uninsured · Release a detailed research report outlining the costs of being uninsured to businesses and workers · Highlight compelling personal stories from the perspectives of business and labor about the uninsured
Potential participants · Local Chambers of Commerce · Local labor unions and members · Major employers in the region · Small businesses · Corporate sponsors · Uninsured people · Health Care Purchasing Alliances
Potential locations Hotel conference centers, union halls, Chamber of Commerce offices, schools, hospitals, etc. *******************************
Off hand, this looks very reasonable. Business and labor are both significantly impacted by the funding structure of our health care system, and they should have input to the reform process. But there are two striking features of Thursday's agenda. One is the intense involvement and support heavily weighted to all sectors of the business community, with labor playing a supporting role, and with all other stakeholders excluded. This is particularly significant since intense media coverage is scheduled for that day.
The other subtle but crucial feature is the key phrase buried in the concept proposal, and that phrase is, "strengthening employer-based coverage." It is most likely more than a coincidence that this is the policy supported by the U.S. Chamber of Commerce and the Health Insurance Association of America. In the absence of a universal health insurance program, most of the other organizations also believe, quite correctly, that we need to support employer funding of health care.
Of course, the single payer model would eliminate the employment link, but, as the initial press conference demonstrated, the single payer model has been excluded. By establishing firmly the principle that employer-based coverage must be strengthened, there will be no consideration of national health insurance, whether Medicare for All or a single payer program.
Also it is unfortunate that both the interfaith and arts communities are being enlisted to join in a massive effort to assist the uninsured without being informed that they are supporting the agenda of those that would benefit from an employer-based model.
Is there enough sound reason for all of us to support an employer-based model? What would that look like? Would it be play or pay? Would there be a mandate for employers to purchase plans or contribute to a fund?
Two measures might bring support to play or pay. One is that insurance benefit mandates could be eliminated, making the purchase of employer-based plans affordable. The plans could be stripped of benefits and/or shift a major portion of the costs to individuals, both of which are questionable policies because they erect financial barriers to care for those that have the greatest health care needs. This is hardly the purpose of health care coverage.
Another measure which could draw the support of business is to provide tax credits to make the purchase of plans more affordable for businesses. Much has been written about tax credits, whether for the employer or for the beneficiary, and there are very significant negative policy implications with various tax credit proposals. One of the most serious defects is that, to be effective, the credits must be very large, using public dollars to continue to feed the tremendous administrative waste characteristic of our fragmented system of health plans.
Probably the greatest concern about employer-based coverage is that it leaves in place most of the flawed policies of our current system. Expanding coverage under our current system of funding care will cause a further increase in health care costs, perpetuating one of the primary problems in health care that we should be addressing. An employer-based program would require continuation of a safety net public program, such as Medicaid. The under-funding and lack of willing providers would continue to threaten access for those dependent on the public program. Employers would want to have access to other programs with serious policy deficits such as association health plans, consumer-driven products, especially MSA-type individually delegated accounts, and a greater market for "affordable" insurance products devoid of protection for the beneficiaries. And public "welfare" programs continue to experience revolving door enrollment, leaving many without coverage at any given time. In contrast, a program of social insurance, such as Medicare, has virtually 100%, permanent enrollment.
An employer-based system of coverage that came close to including all of the uninsured would increase health care costs and would increase inequities in our system, inequities in the way we fund health care and inequities in the access to health care. Insuring the Uninsured Week appears to be specifically designed to promote this approach. Other approaches would be granted a day of token discussion in academic environments. But Tuesday, the On Campus day, has activities limited to campuses with no significant media outreach. It is most likely understood by those supporting the employer-based model that academic centers are not very effective in converting sound ideas into public policy. The On Campus concepts that leak into the massive media events of Thursday can be dismissed readily with simple sound bites ("Americans don't want socialized medicine").
It is important that Americans understand that we can provide equitable access to comprehensive health care services for everyone, fund it equitably, and contain health care costs through a publicly administered program of universal health insurance. The Cover the Uninsured Week process will not deliver that message. In fact, it seems to be designed to suppress it.
What can we do?
Two major elements are supporting the Covering the Uninsured project. Some are very self-serving and would benefit greatly from the employer-based model to be advanced by this process, especially HIAA. Others are truly concerned about issues of health care justice and want to move us closer to a system that would approve access and coverage. After decades of thwarted efforts, these individuals and organizations believe that the process will require compromise. Although we agree that the political hurdles appear to be almost insurmountable, we also believe that we must take the strongest stand on behalf of health policies that will bring us the best system possible within the limits of our resources. These policies are achievable, though not without an enormous effort on our part.
Individuals that are active in the coalition organizations that do support health care justice and individuals that work closely with those organizations should immediately open new discussions of policy solutions for our health care system. Special attention must be given to the policy implications of the employer-based agenda for Cover the Uninsured Week. In my opinion, an investigation should be undertaken to determine why an apparent effort has been made to limit policy considerations to a narrow model that would be self-serving for some members of the coalition, but risks increasing costs and inequities for the rest of us. Those responsible should recommit to an open process or withdraw.
If the agenda proved to be inflexible, then some might consider discrediting the process and then initiate another campaign to widely publicize the benefits of an equitable and affordable system of funding health care. But discrediting the Covering the Uninsured process should be avoided since a negative approach would be detrimental to the entire health care reform movement. The Covering the Uninsured process does have the important potential for educating the public on the problem and, very importantly, on rational solutions, if the process is not commandeered by self-serving interests. It would be far, far better to work to assure that all reasonable policy options are publicized than to try to defeat yet one more effort at reform.
Our friends in the coalition really do care - as much as we do. We must make every effort to convince them to return to a consideration of fundamental issues of sound policy and to include those options in the media events for the Covering the Uninsured process.
We already have the resources for comprehensive care for everyone. Sound public policy could assure that our resources benefit us all, equitably and efficiently. Employer-based coverage would fall short of these goals. A publicly administered program of universal insurance would establish equity and efficiency while providing affordability. The public needs to understand that. Let's all work together to be sure that they do.
Don McCanne
Please circulate this to people that do care and want to work together to support sound policies of health care justice.
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Professor Donald W. Light on Covering the Uninsured:
Covering the Uninsured is not likely to have much success beyond another round of gap-filling efforts, unless it includes covering the under-insured and the thinning of coverage that is now the chief policy of employers, through higher cost-sharing and thinning of services covered. The Foundation leaders love CHIP. CHIP has been their great hope. If we want the nation to think beyond CHIP-like solutions, this campaign has to be broader and speak to the majority of employees and employers about how the employer-based system is falling apart and making businesses less competitive in global markets by burdening them with the costly side issue to their main products or services.
=-=-=-=-=-= Bob Griss, Director, Center on Disability and Health, on Covering the Uninsured:
If the underlying aim of the $10 million dollar Robert Wood Johnson Foundation funded "Strange Bed-fellows" campaign is to discredit universal health care approaches like single payer or Medicare-For-All by focusing only on incremental approaches, there are four strategies that advocates for universal health care should prepare for.
One is to demonstrate the limitations of the incremental approaches like the current structure of CHIP, tax credit approaches, Medical Savings Accounts, and Associated Health Plans that have distracted Congress every time the plight of the uninsured has been debated over the last several years.
A second strategy is to demonstrate the advantages of universal health care at the national or state levels to overcome the problems that incremental approaches create. This approach can benefit from highlighting the experiences in other countries with different forms of universal health care distinguishing between the structure of the program and the level of resources that are devoted to health care in their systems compared to the public and private dollars that are devoted to health care in the US.
A third approach is to dispel the myths about universal health care that have been promoted by special interests who benefit from market-driven health care. Among these myths are that quality would suffer, individual choice would be constrained, and costs would increase.
Fourthly, besides dispelling these fears, we need to identify policy changes that would become possible under universal health care such as being able to conduct quality assurance efficiently and effectively, and reward providers for functional outcomes rather than just for procedures delivered as a mechanism for cost containment.
The challenge is not to convince the public that the uninsured have a problem, but to demonstrate how with the resources currently provided, all people can be better off under universal health care. This message must be taken to Town Hall meetings, academic centers that train health professionals, community health fairs, union halls and corporate boardrooms, religious organizations, and the institutions which shape our mass culture. The goal of this effort should be to create a social movement for a right to health care in the US that works not just for special interests but for the whole society.
Bob Griss, Director Center on Disability and Health, Co-chair, Health Task Force of the Consortium for Citizens with Disabilities and Board Member, UHCAN