The Washington Post
June 23, 2002
By Warren A. Jones, President of the American Academy of Family Physicians
The mantra is “incremental steps” — not because incrementalism is the right approach but because it is viewed as the only politically viable one. All the evidence, however, says that it’s the wrong approach and that it won’t work.
Incrementalism won’t work, because the problems are systemic. Reducing the ranks of the uninsured by a million or 2 million is a short-term victory in human terms. But adding them into a broken health care system is a long-term strategy doomed to fail.
This system must be overhauled. Any successful plan will require that everyone be covered — so we can reduce the huge hidden cost we are all paying in emergency rooms, neonatal intensive care units and all the other places where the uninsured wind up getting care. Just because one attempt at comprehensive reform failed in the early 1990s is no reason to say it cannot be done. It must be done. It’s time for new approaches.
The Academy of Family Physicians has a plan to fundamentally restructure the system. It’s called Assuring Health Care Coverage for All, and it is based on three principles:
* Basic health care services and protection against catastrophic costs to be guaranteed to everyone.
* Health care to be funded through a national, broad-based taxing mechanism. Everyone benefits, and everyone shares the expense.
* The current insurance market to be maintained, including employer-based and individually purchased insurance.
Americans know it’s time to act. Let’s get to the hard discussion about how to do so as quickly as possible. Our proposal is on the table. We are ready to debate the issue and work with others toward a solution.
Comment: The American Academy of Family Physicians has taken a giant step forward in expanding the national discourse on health care reform. AAFP recognizes that “politically viable” incremental steps fail to meet the goals of universality and equitable funding. They have placed on the table a proposal that mandates these goals. Although their proposal falls short on several other goals of reform, they are willing to debate and work with others on a solution.
The single payer model now has been firmly established as the most credible model of reform. Single payer needs to be on the table with the other proposals, but with representatives that refuse to compromise on issues of health care justice merely because an empirical decision is made to maintain the current insurance market. Fundamental ethical principles of health policy must provide the framework for the process. If those at the table sincerely believe that our resources must be directed to providing the best care possible for absolutely everyone, then the right decisions will be made.
