Interim Recommendations of the Citizens' Health Care Working Group
Interim Recommendations of the Citizens’ Health Care Working Group June 1, 2006
The Citizens’ Health Care Working Group was created by the Medicare Prescription Drug, Improvement and Modernization Act of 2003, Sec. 1014 to provide for the American public to “engage in an informed national public debate to make choices about the services they want covered, what health care coverage they want, and how they are willing to pay for coverage.”
Following this nationwide citizen engagement, the Working Group is required to prepare and make available to the public this interim set of recommendations on “health care coverage and ways to improve and strengthen the health care system based on the information and preferences expressed at the community meetings.” Following a 90-day public comment period on these recommendations, the Working Group will submit to Congress and the President a final set of recommendations.
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.
Interim report:
http://www.citizenshealthcare.gov/recommendations/interim_recommendations.pdf
Comment:
By Don McCanne, M.D.
Those who have followed and participated in this process should agree that the “common message” above represents the prevailing views of the participants. We want a universal, comprehensive, high-quality system that does not endanger financial security for anyone.
Unfortunately, some of the actual details of the report do not seem to reflect this view but rather reflect the opinions of the current administration. Following, in quotations, are a few excerpts from the report, each followed by my comment.
- “No specific health care financing mechanism is optimal.”
There was a clear preference for an equitable, progressively-funded system of insurance for everyone. The administration’s tax credit proposal was rejected by most of those who were offered that option in the sessions. This statement seems to reflect the opinion of the individuals preparing the report rather than the view of the majority of citizens participating.
- “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.”
Incrementalism was not a concept discussed in the sessions. This statement, calling for an incremental process, also seems to represent the view of those preparing the report.
- “Define a ‘core’ benefit package for all Americans”
“Core” is a term selected by those preparing this report which suggests that only basic services should be covered by a universal program, and that, by inference, second-tier benefits should be provided only for those who can afford them. The “common message” in this report states that benefits should be “sufficiently comprehensive to provide access to appropriate, high-quality care.” However “core” is defined, it implies that access to other appropriate care will be impaired due to financial barriers. This does not seem to be the intent of the citizen-participants.
- “Guarantee financial protection against very high health care costs”
The report does call for financial protection for low-income individuals, but out-of-pocket health care expenses now threaten average-income Americans. Protection against “very high health care costs” is a call for high-deductible, catastrophic coverage, a policy supported by the administration. In contrast, the majority consensus of the citizen-participants is that the system should not endanger “individual or family financial security,” though many participants seemed to be uninformed about the adverse consequences of high-deductible health plans.
- “Expanding and modifying the Federally Qualified Health Center concept to accommodate other community-based health centers and practices serving vulnerable populations”
Rather than ensuring that every individual has comprehensive health care coverage, the administration supports the expansion of community health centers to serve low-income individuals, especially those who are uninsured.
Although community health centers serve a very important role, they should not be viewed as a substitute for adequate health care coverage.
- “Consumer-usable information about health care services that includes information on prices, cost-sharing, quality and efficiency, and benefits”
This statement supports the consumer-directed health care movement, the current market diversion from the need to focus on a comprehensive system of health care coverage.
It is likely that members of Congress will select those portions of this report that support their own individual agendas while ignoring the overriding message supporting an equitable, comprehensive, high-quality system for everyone. The Working Group has requested comments on this interim report before it is formally submitted to the President and Congress. You should provide those comments to help ensure that this process is not hijacked by the opponents of comprehensive reform.
Use the following link to submit your comments on the interim recommendations: http://www.citizenshealthcare.gov/speak_out/ircomment1.php