We have two healthcare systems in America. People who can afford insurance get the best care in the world. But most families are one bad break, such as a lost job or a serious illness, away from going right off a cliff.
I believe we should build one America, with one health system where every person can get decent, affordable healthcare. I am proud to be the first major presidential candidate to propose a specific plan to guarantee true universal healthcare.
Under my plan, businesses would either cover their employees or help pay their premiums. The government would make insurance affordable through new tax credits and by leading the way toward more cost-effective care. New “healthcare markets” would give families and businesses purchasing power and a choice of quality plans, including one public plan. Finally, once these steps have been taken, all American residents would be required to take responsibility and get insurance.
Under my plan, families without insurance would get coverage at an affordable price. Families that have insurance today—who sometimes have trouble paying their share of health insurance payments—would pay less and get more security and choices. Businesses and other employers would find it cheaper and easier to insure their workers. I have proposed steps that would save an average family $2,000 to $2,500 a year and eliminate at least $130 billion a year in wasteful healthcare spending.
An innovative feature of my plan would give individuals in healthcare markets a choice of insurance plans including a public plan based on Medicare. That choice would force private insurers to operate in a more competitive market, holding down costs and improving care.
I also recognize that we cannot achieve true universal care without making additional transitional investments. I have been honest about how I would pay for these—by repealing President Bush’s income tax cuts for Americans who make more than $200,000 per year.
To improve quality and reduce costs, I believe it’s time for a new era in chronic and preventive care. Chronic diseases account for three-quarters of national healthcare spending. Helping patients and providers to manage these illnesses and avoid unnecessary hospitalizations can improve health and dramatically reduce healthcare costs. Additionally, less than 5% of total U.S. healthcare spending goes toward prevention.
My plan would revolutionize chronic-care management and require prevention. I would require healthcare markets and public plans to monitor chronically ill patients’ health to reduce complications and hospitalizations, and would offer private plans incentives to do the same. Vermont is demonstrating that this kind of new approach to managing chronic care can improve patients’ health and save money. I would also require preventive-care coverage, with public plans offering preventive care without copayments, and provide incentives for patients to participate.
I want to move our healthcare delivery system toward patient-centered “medical homes.” Ninety percent of Medicare dollars are spent on people with three or more conditions, who usually see multiple specialists. At the same time, the number of new family practitioners has dropped 50%, in part because we don’t properly value primary care. Starting with Medicare and other public plans, I would help transform how healthcare is delivered by changing reimbursement rules to emphasize primary care. Primary-care physicians would guide care for patients to ensure they are getting proven treatment from a coordinated team.
To make healthcare more affordable, we need to make sure insurance companies help people. Without new rules, insurance companies could continue to charge hardworking families excessive premiums, pocketing the savings from healthcare reform instead of delivering more to patients. Building on state efforts, I would set national accounting standards requiring insurers to spend at least 85% of their premiums on patient care. The standards would also create a more efficient system. Today, 30 cents of every dollar spent on healthcare goes toward administration and system waste.
It is critical that we improve care with technology and empower providers to deliver the best possible healthcare. Electronic health records could save the system as much as $162 billion annually. I would require providers to use interoperable information technology that protects privacy, bring the private sector together to establish standards and provide targeted help with implementation where necessary.
It’s time we made sure every healthcare provider practiced evidence-based medicine. I would create a new independent research institute to analyze new devices and treatments and disseminate its findings, and I would develop partnerships among academic medical centers, Medicare and other agencies to make high-quality medicine contagious.
I would also provide incentives for quality and reducing medical errors. Under the fee-for-service model, a hospital that makes a medical error is often paid for the error and then paid again to fix it. Under my plan, Medicare and other federal programs would lead the way in paying for performance.
At the same time, we must reduce the cost of practicing medicine with common-sense reforms that help doctors and patients. I support mandatory sanctions for lawyers who file frivolous cases; stronger state medical disciplinary boards; and a knowledge bank that encourages doctors to report medical errors voluntarily, making others aware of preventable mistakes.
We have to stop using words like “access to healthcare” when we know with certainty those words mean something less than universal care. Who are you willing to leave behind without the care they needs? Which family? Which child? We need a truly universal solution, and we need it now.