Health Care in the U.S.

By Jackie Speier

• The number of uninsured is rising, now 47 million people, while the number of employers providing health insurance is declining.

• Significantly, the long and short-term consequences of the decline in coverage disproportionately affect children and the middle class (KFF.org).

• Evidence-based care is provided only 50% of the time, and widespread variation in costs of care for common conditions suggests inconsistent quality of care (Wennberg, McGlynn). The time to change is long overdue.

• I strongly believe the U.S. health care system is broken and needs a major overhaul. We need a system that families can count on to access affordable, high quality care, where employers can rely on a healthy and productive workforce, and health care providers have the resources to provide the best care in a meaningful, efficient and cost-effective way.
• We need a program of universal access to healthcare based on individual and employer mandates with contribution caps for individuals and small businesses. We need a standard minimum benefit package that is fully transportable; and we need an information infrastructure and system of performance incentives to produce safe, effective, patient-centered, timely, efficient, and equitable care as proposed by the Institute of Medicine (IOM-Chasm, 2001).

• Individual mandates with limits on the proportion of income contributed towards premiums are necessary so that everyone is covered and so that no person will be faced with the untenable position of choosing between seeking treatment or buying medication and providing food for their families. This type of system will minimize cost shifting from the uninsured to the privately insured and reduce uncompensated care. 

• Employer mandates, with contribution caps for small employers, will continue the current system in which employers contribute to the well being of their employees through contributions to the cost of premiums. Employer mandates would create the infrastructure that would allow for the extension of benefits to all employed individuals, while helping to reduce the burden of uncompensated care.

• A fully transportable standard minimum benefit package, including pharmacy and mental health benefits, will assure individuals that the coverage they get will be sufficient to meet their needs and they would never need to experience periods of un-insurance during transitions between jobs.

• A robust, fully accessible information infrastructure will extend the work currently being done, which compares individual provider performance to current best evidence, provides information to these providers so they can improve their performance, and to consumers so they can make the best choices for care for themselves and their families. A system of incentives based on this information would improve the quality of care and has the potential for significant cost-savings (PBGH actuarial report).

• We must solve this problem. The effort in California took just nine months to blow up. It is clear that a federal solution is best. This issue is complicated, but not so complicated that it cannot be fixed. We are a great country, we have solved seemingly insurmountable problems, and we can solve this one.