RAND Health

COMPARE is a transparent, evidence-based approach to providing information and tools to help policymakers, the media, and other interested parties understand, design, and evaluate health policies.

COMPARE has four objectives:

* Synthesize what is known about the current health care system.

* Describe policy options that have been proposed to address one or more existing challenges.

* Analyze the effects of different health care policy options on multiple dimensions of health system performance.

* Identify gaps in our knowledge about the effects of policy changes.

COMPARE was developed to help public and private decisionmakers systematically assess and compare the effects of different policies across multiple dimensions of health care system performance, encompassing cost, quality, and access. COMPARE gives users a comprehensive framework in which to examine both the intended and unintended effects of changes in health care policy and to examine trade-offs across policies, or across different dimensions of performance for any particular policy (e.g., the effect on spending compared to the effect on insurance coverage or on patient experience).

The Web site includes four main sections, U.S. Health Care Today, Policy Options, Analysis of Options, and Modeling Estimates.

http://www.rand.org/health/feature/compare/

Press release:
http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/01-13-2009/0004954039&EDATE=

And…

RAND COMPARE

Policy Options – Change Insurance Coverage

* Individual Mandate
* Employer Mandate
* Purchasing Pools
* Refundable Tax Credit
* Medicaid/SCHIP Eligibility
* Open Enrollment in FEHBP

Modeling Estimates – Policy Options

* Tax Credit
* Medicaid Expansion
* Individual Mandate
* Employer Mandate

Who funds COMPARE?

AARP
Abraxis BioScience, Patrick Soon-Shiong MD, Founder, Chairman, and CEO
Aetna Foundation
Alcoa
Amgen Foundation
Blue Cross Blue Shield of Massachusetts
California HealthCare Foundation
The Funari Family Foundation
General Motors Foundation
Johnson & Johnson
Karen Katen
Charles N. Martin Jr., The Martin Foundation
Pacific Business Group on Health
Pfizer
RAND Corporate Endowment
RAND Health Board, designated gifts from individual members
Robert Wood Johnson Foundation
John J. Rydzewski
Leonard D. Schaeffer
The Suzanne Nora Johnson and David G. Johnson Foundation
United Health Foundation
Wellpoint Foundation

http://www.randcompare.org/

To generate custom reports:
http://www.randcompare.org/analysis/reports/

Comment:

By Don McCanne, MD

RAND COMPARE provides both a valuable information resource on U.S. health care today, and an interactive tool that can be used to evaluate the impact of various policy options under different models of reform. It has now been released for public use.

Elizabeth McGlynn and Jeffrey Wasserman are codirectors of COMPARE. On a Webinar event January 13, the release of COMPARE was announced along with a discussion of how it works. When I noted that a single, public insurance model (single payer or Medicare for all) was not an option available on the COMPARE website, Dr. McGlynn assured me that it was a model that should be added.

In their press release they stated, “An individual mandate is the most cost-effective strategy for decreasing the number of uninsured.” Innumerable other studies comparing models of reform have shown that a single payer model is the most cost-effective strategy and actually eliminates the uninsured. Models based on private insurance, such as the individual mandate, have been shown to be less effective, according to these other studies.

The sponsors surely support RAND’s function as “a nonprofit research organization providing objective analysis,” and would want to see that objective data on the single payer model be made available immediately for comparison with the other options.

Since we are entering a period of intense activity in health care reform, it would be helpful to have the single payer model added as expeditiously as possible. If you agree, then please send a very brief message requesting that single payer be added ASAP. Email them at: COMPARE@rand.org

You may wish to share this message with others and ask them to make the same request.

Big Health Insurer Agrees to Update Its Fee Data

By Danny Hakim and Reed Abelson
The New York Times
January 13, 2009
In a settlement with one of the nation’s biggest insurers, New York’s attorney general, Andrew M. Cuomo, has ordered an overhaul of the databases the industry uses to determine how much of a medical bill is paid when a patient uses an out-of-network doctor.
A statement from Mr. Cuomo’s office said the industry had engaged in “a scheme to defraud consumers” by systematically underpaying the nation’s patients by hundreds of millions of dollars over the last decade.
The move, to be announced Tuesday, is part of a settlement with the insurance giant UnitedHealth Group, which operates the industry databases. It results from a yearlong investigation by Mr. Cuomo’s office that concluded the data had understated the true market rates of medical care by up to 28 percent.
The settlement will have a nationwide impact because UnitedHealth, the biggest health insurer in New York, operates the databases used by the entire industry, through its Ingenix business unit. The deal calls for creation of a new independent database, to be run by a university that is still to be selected.
Because insurers typically reimburse patients for only 70 to 80 percent of the “reasonable and customary” cost of medical services when they visit doctors outside the insurer’s designated network of physicians, the patient can get shortchanged if the insurer understates the prevailing local fees.
According to Mr. Cuomo, the databases consistently understated the local “reasonable and customary” rates, which Ingenix collects from insurers. The report of the investigation’s findings described the industry calculations as “created in a well of conflicts” that produced information that was “unreliable, inadequate and wrong.”
In an interview Monday, Mr. Cuomo said: “For years this database was treated as credible and authoritative, and consumers were left to accept its rates without question. This is like pulling back the curtain on the wizard of Oz. We have now shown that for years consumers were consistently low-balled to the tune of hundreds of millions of dollars.”
The inability to decipher the insurer’s calculations can be overwhelming to patients with serious medical conditions.
Mary Jerome, a professor at Columbia who was found to have ovarian cancer in 2006, said she had been left with unreimbursed medical bills amounting to tens thousands of dollars. Her complaints to the attorney general’s office helped spur the investigation.
Ms. Jerome, who said she had been treated at Memorial Sloan Kettering, in large part because her primary care physician recommended the hospital, expected she would have to pay no more than her $3,000 deductible for going out of network. But she said she had soon been swamped with bills that left her $70,000 to $80,000 in debt.
Karen Ignagni, the president and chief executive of the industry trade group America’s Health Insurance Plans, praised UnitedHealth for its “major leadership effort” in reaching the agreement.
http://www.nytimes.com/2009/01/13/health/policy/13care.html?ref=business&pagewanted=all

The administrative waste of private insurers along with the excessive administrative burden they place on the health care delivery system alone is more than enough to warrant dismissing them as stewards of our health care dollars. A more fundamental moral reason to dismiss them is that they place service to patients in a secondary position to their efforts to achieve business success, frequently using dishonest deception to do so.
A prime example is this instance in which they have engaged in “a scheme to defraud” their own beneficiaries by deliberately falsifying the “reasonable and customary” cost of medical services. This is not simply an accounting trick to keep more money. This is thievery which has a negative impact on their own clients’ financial and physical health.
The experience of Professor Mary Jerome of Columbia demonstrates how nefarious this industry is. She had a $3000 deductible policy and used it at Memorial Sloan Kettering. You would think that this policy would allow her to obtain the care she needed without having to face financial hardship. But, no. She has been “swamped with bills that left her $70,000 to $80,000 in debt.”
Although New York’s attorney general has removed control of this data base from these crooks, they will continue to introduce more innovations that will enhance their bottom lines at the expense of patients and their health care professionals. The explosion in medical debt experienced by insured patients is proof that their innovations have the nefarious intent of defrauding their own beneficiaries.
And what does Karen Ignagni of AHIP have to say about this fraud? She praises UnitedHealth for its “major leadership effort.” Worse yet, what does it say about those controlling our national dialogue on reform when Karen Ignagni is included in almost every major forum, and single payer advocates such as the leadership of PNHP are deliberately excluded?
Do we really value these dishonest businessmen more than we value the health and financial security of our people?

By Danny Hakim and Reed Abelson
The New York Times
January 13, 2009

In a settlement with one of the nation’s biggest insurers, New York’s attorney general, Andrew M. Cuomo, has ordered an overhaul of the databases the industry uses to determine how much of a medical bill is paid when a patient uses an out-of-network doctor.

A statement from Mr. Cuomo’s office said the industry had engaged in “a scheme to defraud consumers” by systematically underpaying the nation’s patients by hundreds of millions of dollars over the last decade.

The move, to be announced Tuesday, is part of a settlement with the insurance giant UnitedHealth Group, which operates the industry databases. It results from a yearlong investigation by Mr. Cuomo’s office that concluded the data had understated the true market rates of medical care by up to 28 percent.

The settlement will have a nationwide impact because UnitedHealth, the biggest health insurer in New York, operates the databases used by the entire industry, through its Ingenix business unit. The deal calls for creation of a new independent database, to be run by a university that is still to be selected.

Because insurers typically reimburse patients for only 70 to 80 percent of the “reasonable and customary” cost of medical services when they visit doctors outside the insurer’s designated network of physicians, the patient can get shortchanged if the insurer understates the prevailing local fees.

According to Mr. Cuomo, the databases consistently understated the local “reasonable and customary” rates, which Ingenix collects from insurers. The report of the investigation’s findings described the industry calculations as “created in a well of conflicts” that produced information that was “unreliable, inadequate and wrong.”

In an interview Monday, Mr. Cuomo said: “For years this database was treated as credible and authoritative, and consumers were left to accept its rates without question. This is like pulling back the curtain on the wizard of Oz. We have now shown that for years consumers were consistently low-balled to the tune of hundreds of millions of dollars.”

The inability to decipher the insurer’s calculations can be overwhelming to patients with serious medical conditions.

Mary Jerome, a professor at Columbia who was found to have ovarian cancer in 2006, said she had been left with unreimbursed medical bills amounting to tens thousands of dollars. Her complaints to the attorney general’s office helped spur the investigation.

Ms. Jerome, who said she had been treated at Memorial Sloan Kettering, in large part because her primary care physician recommended the hospital, expected she would have to pay no more than her $3,000 deductible for going out of network. But she said she had soon been swamped with bills that left her $70,000 to $80,000 in debt.

Karen Ignagni, the president and chief executive of the industry trade group America’s Health Insurance Plans, praised UnitedHealth for its “major leadership effort” in reaching the agreement.

http://www.nytimes.com/2009/01/13/health/policy/13care.html?ref=business&pagewanted=all

Comment:

By Don McCanne, MD

The administrative waste of private insurers along with the excessive administrative burden they place on the health care delivery system alone is more than enough to warrant dismissing them as stewards of our health care dollars. A more fundamental moral reason to dismiss them is that they place service to patients in a secondary position to their efforts to achieve business success, frequently using dishonest deception to do so.

A prime example is this instance in which they have engaged in “a scheme to defraud” their own beneficiaries by deliberately falsifying the “reasonable and customary” cost of medical services. This is not simply an accounting trick to keep more money. This is thievery which has a negative impact on their own clients’ financial and physical health.

The experience of Professor Mary Jerome of Columbia demonstrates how nefarious this industry is. She had a $3000 deductible policy and used it at Memorial Sloan Kettering. You would think that this policy would allow her to obtain the care she needed without having to face financial hardship. But, no. She has been “swamped with bills that left her $70,000 to $80,000 in debt.”

Although New York’s attorney general has removed control of this data base from these crooks, they will continue to introduce more innovations that will enhance their bottom lines at the expense of patients and their health care professionals. The explosion in medical debt experienced by insured patients is proof that their innovations have the nefarious intent of defrauding their own beneficiaries.

And what does Karen Ignagni of AHIP have to say about this fraud? She praises UnitedHealth for its “major leadership effort.” Worse yet, what does it say about those controlling our national dialogue on reform when Karen Ignagni is included in almost every major forum, and single payer advocates such as the leadership of PNHP are deliberately excluded?

Do we really value these dishonest businessmen more than we value the health and financial security of our people?

Big Health Insurer Agrees to Update Its Fee Data

By Danny Hakim and Reed Abelson
The New York Times
January 13, 2009

In a settlement with one of the nation’s biggest insurers, New York’s attorney general, Andrew M. Cuomo, has ordered an overhaul of the databases the industry uses to determine how much of a medical bill is paid when a patient uses an out-of-network doctor.

A statement from Mr. Cuomo’s office said the industry had engaged in “a scheme to defraud consumers” by systematically underpaying the nation’s patients by hundreds of millions of dollars over the last decade.

The move, to be announced Tuesday, is part of a settlement with the insurance giant UnitedHealth Group, which operates the industry databases. It results from a yearlong investigation by Mr. Cuomo’s office that concluded the data had understated the true market rates of medical care by up to 28 percent.

The settlement will have a nationwide impact because UnitedHealth, the biggest health insurer in New York, operates the databases used by the entire industry, through its Ingenix business unit. The deal calls for creation of a new independent database, to be run by a university that is still to be selected.

Because insurers typically reimburse patients for only 70 to 80 percent of the “reasonable and customary” cost of medical services when they visit doctors outside the insurer’s designated network of physicians, the patient can get shortchanged if the insurer understates the prevailing local fees.

According to Mr. Cuomo, the databases consistently understated the local “reasonable and customary” rates, which Ingenix collects from insurers. The report of the investigation’s findings described the industry calculations as “created in a well of conflicts” that produced information that was “unreliable, inadequate and wrong.”

In an interview Monday, Mr. Cuomo said: “For years this database was treated as credible and authoritative, and consumers were left to accept its rates without question. This is like pulling back the curtain on the wizard of Oz. We have now shown that for years consumers were consistently low-balled to the tune of hundreds of millions of dollars.”

The inability to decipher the insurer’s calculations can be overwhelming to patients with serious medical conditions.

Mary Jerome, a professor at Columbia who was found to have ovarian cancer in 2006, said she had been left with unreimbursed medical bills amounting to tens thousands of dollars. Her complaints to the attorney general’s office helped spur the investigation.

Ms. Jerome, who said she had been treated at Memorial Sloan Kettering, in large part because her primary care physician recommended the hospital, expected she would have to pay no more than her $3,000 deductible for going out of network. But she said she had soon been swamped with bills that left her $70,000 to $80,000 in debt.

Karen Ignagni, the president and chief executive of the industry trade group America’s Health Insurance Plans, praised UnitedHealth for its “major leadership effort” in reaching the agreement.

http://www.nytimes.com/2009/01/13/health/policy/13care.html?ref=business&pagewanted=all

Comment:

By Don McCanne, MD

The administrative waste of private insurers along with the excessive administrative burden they place on the health care delivery system alone is more than enough to warrant dismissing them as stewards of our health care dollars. A more fundamental moral reason to dismiss them is that they place service to patients in a secondary position to their efforts to achieve business success, frequently using dishonest deception to do so.

A prime example is this instance in which they have engaged in “a scheme to defraud” their own beneficiaries by deliberately falsifying the “reasonable and customary” cost of medical services. This is not simply an accounting trick to keep more money. This is thievery which has a negative impact on their own clients’ financial and physical health.

The experience of Professor Mary Jerome of Columbia demonstrates how nefarious this industry is. She had a $3000 deductible policy and used it at Memorial Sloan Kettering. You would think that this policy would allow her to obtain the care she needed without having to face financial hardship. But, no. She has been “swamped with bills that left her $70,000 to $80,000 in debt.”

Although New York’s attorney general has removed control of this data base from these crooks, they will continue to introduce more innovations that will enhance their bottom lines at the expense of patients and their health care professionals. The explosion in medical debt experienced by insured patients is proof that their innovations have the nefarious intent of defrauding their own beneficiaries.

And what does Karen Ignagni of AHIP have to say about this fraud? She praises UnitedHealth for its “major leadership effort.” Worse yet, what does it say about those controlling our national dialogue on reform when Karen Ignagni is included in almost every major forum, and single payer advocates such as the leadership of PNHP are deliberately excluded?

Do we really value these dishonest businessmen more than we value the health and financial security of our people?

Squeezed! Caught between Unemployment Benefits And Health Care Costs

Families USA
January 2009
By November 2008, more than 2.7 million people had joined the ranks of the unemployed since the recession began in 2007, and 10.3 million people were unemployed. Many of those people (and their families) lost their health coverage when they lost their jobs.
Some workers who had insurance through their former employers may be able to continue to purchase the same coverage — but they must pay the full cost out of their own pockets. This continuation coverage, called “COBRA” (from the Consolidated Omnibus Budget Reconciliation Act of 1986), could provide a vital health care lifeline for many families. Unfortunately, for most individuals and families, the cost of this coverage is prohibitively high, especially when compared to average unemployment benefits.
$1278 – Average monthly unemployment income
$388 – Average COBRA premium for an individual
30% – Premium as a share of unemployment income
$1069 – Average COBRA premium for a family
83% – Premium as a share of unemployment income
Conclusion
As our nation faces a severe recession, growing numbers of unemployed workers and their families are coping with the loss of health insurance. The short- and long-term physical and financial consequences of such a loss can be devastating. COBRA continuation coverage can be a crucial health lifeline for newly unemployed workers. But while many workers have the right to purchase such coverage, the cost is often prohibitively high. To make COBRA coverage truly affordable, a meaningful subsidy should be provided to recently unemployed workers. For those who do not have a COBRA coverage option, Congress should provide a temporary Medicaid benefit to recently unemployed, low-wage workers.
http://www.familiesusa.org/assets/pdfs/cobra-2009.pdf

Families USA has continued to be a source of highly credible studies demonstrating the severe deficiencies in health care financing in the United States. A prime example is this study of COBRA benefits. Although the intent of COBRA was to allow individuals and families to maintain their employer-sponsored coverage after losing their jobs, this study demonstrates that this is yet another failed policy as unemployed individuals are unable to pay for that coverage.
Unfortunately, the conclusion of this study also represents yet another inadequate policy recommendation of Families USA. The obvious conclusion is that health insurance must be automatic, for life, and comprehensive enough to prevent financial hardship regardless of income or health status. Instead, Families USA would leave this flawed COBRA program in place, and merely tweak it so that a few of the 46 million uninsured could receive coverage. Temporary Medicaid? Come on!
It is no secret that PNHP and Families USA have had their differences. The leadership of PNHP has demonstrated that a single payer national health program would provide affordable health care for everyone throughout life. The leadership of Families USA has continued to insist that single payer is not feasible, and that reform must occur in incremental steps – increments such as subsidies for COBRA benefits.
We have been following for decades their preferred course of incremental reform, and all parameters are worse. We have an outrageously expensive system with increasing numbers of uninsured and underinsured, and ever greater financial hardship for those individuals and families with health care needs. Of nineteen industrialized nations, we have the worst rate of amenable mortality (premature deaths which are preventable). Incrementalism has been a cruel, miserable policy failure in the United States.
The leadership of Families USA understands this. Thus for the past decade they have supported “strange bedfellow” coalitions, bringing together organizations that traditionally have been at odds on the reform issues. Each of these efforts has been introduced with considerable fanfare, with the obligatory statements from each participating organization to the effect that finally we are coming together to fix our health care system.
What happens? Behind the scene the opponents of reform continue to sabotage the efforts. The opponents are using the reputation of Families USA to burnish their own tarnished images, while gaining additional years before they must face the inevitability of a bona fide national health program.
The opponents will never support a program that is contrary to their selfish interests or their right-wing ideology. NEVER!
For those who believe that we are close to bringing all interests together on reform, think about this. The leading reform proposal is based on private health plans which everyone knows are no longer affordable, and the Republicans will never approve an adequate “tax on the rich” that would be needed to pay for those plans. The supporters also have recommended the creation of a public insurance option which individuals could purchase (even though it wouldn’t be affordable either). Yet the opponents have blasted the proposal because it is an incremental step towards single payer. AHIP, USCOC and some of the Senate Republicans have made it clear that this is a non-starter.
Forget incrmentalism! Forget sleeping with the enemy!
Ronny, sorry, but what you’ve been doing just hasn’t worked. It’s time for you to get up out of that bed and join us in our crusade for the real thing – health care justice for all.
****
Note of Clarification: What is the fundamental disagreement? One side wants an affordable, high-quality health care system that really does include everyone. The other side is opposed, either because of anti-egalitarian ideology or simply because of selfish self-interest. That is where the battle must take place.
The debate over an incremental versus comprehensive strategy for reform has been an unfortunate digression that has splintered one side – the supporters of health care justice. PNHP, Families USA, UHCAN, Healthcare-NOW!, Health Care for All, the HCAN coalition, and all of the other individuals and organizations that share the common goal of health care for everyone must unify in support of truly comprehensive reform that does not compromise on the policies that will get us there. This goal must have precedence above all others and must represent the primary thrust of our efforts.
That does not mean that there is no place for incremental measures. The Children’s Health Insurance Program (SCHIP) is an incremental measure that must be renewed and expanded immediately, but only as an urgent, temporary measure until we can enact a comprehensive program for everyone, including children.
It is absolutely crucial that we all pull together now, pulling out all the stops, especially while we are in this political window. Once we have a comprehensive system, the incrementalists can have a field day tweaking the inevitable glitches in the system.

Families USA
January 2009

By November 2008, more than 2.7 million people had joined the ranks of the unemployed since the recession began in 2007, and 10.3 million people were unemployed. Many of those people (and their families) lost their health coverage when they lost their jobs.

Some workers who had insurance through their former employers may be able to continue to purchase the same coverage — but they must pay the full cost out of their own pockets. This continuation coverage, called “COBRA” (from the Consolidated Omnibus Budget Reconciliation Act of 1986), could provide a vital health care lifeline for many families. Unfortunately, for most individuals and families, the cost of this coverage is prohibitively high, especially when compared to average unemployment benefits.

$1278 – Average monthly unemployment income

$388 – Average COBRA premium for an individual
30% – Premium as a share of unemployment income

$1069 – Average COBRA premium for a family
83% – Premium as a share of unemployment income

Conclusion

As our nation faces a severe recession, growing numbers of unemployed workers and their families are coping with the loss of health insurance. The short- and long-term physical and financial consequences of such a loss can be devastating. COBRA continuation coverage can be a crucial health lifeline for newly unemployed workers. But while many workers have the right to purchase such coverage, the cost is often prohibitively high. To make COBRA coverage truly affordable, a meaningful subsidy should be provided to recently unemployed workers. For those who do not have a COBRA coverage option, Congress should provide a temporary Medicaid benefit to recently unemployed, low-wage workers.

http://www.familiesusa.org/assets/pdfs/cobra-2009.pdf

Comment:

By Don McCanne, MD

Families USA has continued to be a source of highly credible studies demonstrating the severe deficiencies in health care financing in the United States. A prime example is this study of COBRA benefits. Although the intent of COBRA was to allow individuals and families to maintain their employer-sponsored coverage after losing their jobs, this study demonstrates that this is yet another failed policy as unemployed individuals are unable to pay for that coverage.

Unfortunately, the conclusion of this study also represents yet another inadequate policy recommendation of Families USA. The obvious conclusion is that health insurance must be automatic, for life, and comprehensive enough to prevent financial hardship regardless of income or health status. Instead, Families USA would leave this flawed COBRA program in place, and merely tweak it so that a few of the 46 million uninsured could receive coverage. Temporary Medicaid? Come on!

It is no secret that PNHP and Families USA have had their differences. The leadership of PNHP has demonstrated that a single payer national health program would provide affordable health care for everyone throughout life. The leadership of Families USA has continued to insist that single payer is not feasible, and that reform must occur in incremental steps – increments such as subsidies for COBRA benefits.

We have been following for decades their preferred course of incremental reform, and all parameters are worse. We have an outrageously expensive system with increasing numbers of uninsured and underinsured, and ever greater financial hardship for those individuals and families with health care needs. Of nineteen industrialized nations, we have the worst rate of amenable mortality (premature deaths which are preventable). Incrementalism has been a cruel, miserable policy failure in the United States.

The leadership of Families USA understands this. Thus for the past decade they have supported “strange bedfellow” coalitions, bringing together organizations that traditionally have been at odds on the reform issues. Each of these efforts has been introduced with considerable fanfare, with the obligatory statements from each participating organization to the effect that finally we are coming together to fix our health care system.

What happens? Behind the scene the opponents of reform continue to sabotage the efforts. The opponents are using the reputation of Families USA to burnish their own tarnished images, while gaining additional years before they must face the inevitability of a bona fide national health program.

The opponents will never support a program that is contrary to their selfish interests or their right-wing ideology. NEVER!

For those who believe that we are close to bringing all interests together on reform, think about this. The leading reform proposal is based on private health plans which everyone knows are no longer affordable, and the Republicans will never approve an adequate “tax on the rich” that would be needed to pay for those plans. The supporters also have recommended the creation of a public insurance option which individuals could purchase (even though it wouldn’t be affordable either). Yet the opponents have blasted the proposal because it is an incremental step towards single payer. AHIP, USCOC and some of the Senate Republicans have made it clear that this is a non-starter.

Forget incrmentalism! Forget sleeping with the enemy!

Ronny, sorry, but what you’ve been doing just hasn’t worked. It’s time for you to get up out of that bed and join us in our crusade for the real thing – health care justice for all.

****

Note of Clarification: What is the fundamental disagreement? One side wants an affordable, high-quality health care system that really does include everyone. The other side is opposed, either because of anti-egalitarian ideology or simply because of selfish self-interest. That is where the battle must take place.

The debate over an incremental versus comprehensive strategy for reform has been an unfortunate digression that has splintered one side – the supporters of health care justice. PNHP, Families USA, UHCAN, Healthcare-NOW!, Health Care for All, the HCAN coalition, and all of the other individuals and organizations that share the common goal of health care for everyone must unify in support of truly comprehensive reform that does not compromise on the policies that will get us there. This goal must have precedence above all others and must represent the primary thrust of our efforts.

That does not mean that there is no place for incremental measures. The Children’s Health Insurance Program (SCHIP) is an incremental measure that must be renewed and expanded immediately, but only as an urgent, temporary measure until we can enact a comprehensive program for everyone, including children.

It is absolutely crucial that we all pull together now, pulling out all the stops, especially while we are in this political window. Once we have a comprehensive system, the incrementalists can have a field day tweaking the inevitable glitches in the system.