Final Recommendations of the Citizens' Health Care WorkingGroup
Health Care that Works for All Americans Final Recommendations
Citizens’ Health Care Working Group
Bipartisan legislation created the Citizens’ Health Care Working Group to go to the American people, to explore their values and aspirations for the American health care system, and to bring their ideas and energy for health reform back to Washington.
Appointed by the Comptroller General of the United States, the Citizens’ Health Care Working Group is a nonpartisan body made up of 14 citizens plus the Secretary of Health and Human Services - all from very different backgrounds, experiences within the health care system, and communities across the nation.
Guarantee Financial Protection Against Very High Health Care Costs
By establishing protection against very high medical costs for all, the Working Group’s Recommendation 2 responds to two major messages from the American people. First, people believe that no one should be financially ruined by health care costs. Further, there was overwhelming public support for a new dynamic in American health care where everyone is protected, not just select portions of the population. This Recommendation can be implemented in the short term and provide a basic level of financial protection to those who do not already possess this coverage. Building this system will provide some level of immediate protection for everyone, and also has the potential to stabilize existing employer-based health insurance markets and expand the private individual and small group health insurance markets to more Americans.
After listening to and analyzing the needs and ideas of the American people and discussing the topic with experts, the Working Group developed two possible frameworks that would meet the requirements of universal protection and guard against very high health care costs: The Market-Based and the Social Insurance models.
The Market-Based Model
The basics of the market-based model are as follows:
- All Americans would have to obtain coverage against high out-of-pocket costs.
- Individuals would be offered a choice of standardized high-cost insurance products, whose details would be easy to understand and easy to compare.
- The products would offer protection at different levels of out-of-pocket costs to individuals.
- Individuals would be free to purchase the policy that best suits their needs. Since individuals with the lowest incomes also face impoverishment with all but the most expensive plans, premium subsidies would be provided based on ability to pay, and would diminish with increasing income levels.
- Employers would retain a role in paying for or providing health plans.
The Market-Based Model: An Example
For illustrative purposes only, consider three policies covering the same set of services: (1) Policy A with a deductible of $4,000 in out-of-pocket expenses prior to full coverage of covered services, (2) Policy B with a deductible of $12,000, and (3) Policy C with a deductible of $30,000. These deductible levels are similar to policies currently offered in the individual insurance market. Based strictly on coverage offered, Policy A would have the highest premium, Policy C the lowest premium.
The Social Insurance Model
A second approach is based on a social insurance model:
- All Americans would be required to participate in a federal government program protecting against very high out-of-pocket costs.
- The program, like Medicare, would be administered by the federal government through private-sector contractors.
- The program would be funded through a combination of premiums and earmarked federal revenues. Premiums would be structured to be fair and affordable, based on a sliding scale or surcharges related to income.
- Federal subsidies, based on ability to pay, would be provided to pay premiums.
The Social Insurance Model: An Example
In an illustration of this coverage approach, protection would be provided against out-of-pocket costs for covered services that exceed some percentage of income-such as 20 percent of taxable income above the federal poverty level-or that exceed a fixed dollar amount of individual liability-such as $30,000-whichever is lower.
Final Recommendations (access page):
http://www.citizenshealthcare.gov/recommendations/finalrecs.php
Executive Summary:
http://www.citizenshealthcare.gov/finalrecs/ppd_execsumm.pdf
Recommendations report:
http://www.citizenshealthcare.gov/finalrecs/ppd_recommendations.pdf
Comment:
By Don McCanne, MD
I followed this process closely, and personally participated in it. One common theme I heard repeatedly was that comprehensive health care must be affordable for all Americans. At no time did I ever hear support for the concept that we only need to “guard against VERY HIGH health care costs” (emphasis mine). Even the few who supported high-deductible health plans also supported covering initial costs with health savings accounts. And never did I hear a suggestion that the deductible be in the range of $30,000. Although there was very strong support for single payer social insurance, none of the advocates suggested a deductible of 20 percent of income over the federal poverty level.
I am not surprised by this recommendation. At the start of the process I stated the following in a Quote of the Day:
“It is crucial that we closely observe this process that will result in a vote in Congress on systemic health care changes theoretically designed to bring quality care to every American. The current Comptroller General, David Walker, will appoint 14 of the 15 members and the Chairperson of the Working Group. Since David Walker will be able to control the ideological complexion of the Working Group, we should try to understand his views. Based on his health care forum presentation this month, it appears that he supports incremental reforms in the marketplace that place a greater emphasis on increasing price sensitivity for patients while decreasing the financial insulation provided by insurance.”
(http://www.pnhp.org/news/2004/january/medicare_bill_calls_.php)
I think that it is safe to say that nothing in the process warranted the “very high costs” recommendation, but it is also safe to say that the Comptroller General achieved his goal of producing a report that places “a greater emphasis on increasing price sensitivity for patients while decreasing the financial insulation provided by insurance.”
This process had great potential. We could have seen the best of the American political process at work - a process expressing the will of the American people. Instead it turned out to be another partisan hack job.