Healthcare reform proposals that mix private and public insurance got a boost last week with an endorsement from an influential group of industry players.
This model, advocated by the top three Democratic presidential candidates, ultimately could achieve an efficient, high-performing healthcare system, according to the Commonwealth Funds Commission on a High Performance Health System.
The commission, made up of health policy experts from industry, government, academia and associations, concluded in a 68-page report that universal coverage for the nations 47 million uninsured is essential to cost-containment, and that all Americans should be required to carry health insurance.
We really need to pull everyone into the system, said Sara Collins, an assistant vice president at the Commonwealth Fund and lead author of the report. But the individual mandate has to be coupled with affordability.
The commission categorized proposals into three models. The first, boosting tax incentives for the individual insurance market, is backed by President Bush and Republican presidential candidates Rudy Giuliani, John McCain and Mitt Romney. But this model isnt likely to achieve universal healthcare, and therefore wont help control costs, according to the report.
The second modelmixing private-public group insurance planswas enacted in Massachusetts when Romney was governor, and is proposed by California Gov. Arnold Schwarzenegger. Democratic presidential candidates Hillary Clinton, John Edwards and Barack Obama support this approach as well.
The third category would replace private, employer-based coverage with a single-payer government plan, as proposed by Democratic presidential candidate Dennis Kucinich and others.
Both a public-private group insurance plan and a single-payer public plan could achieve universal healthcare and ultimately lower costs, but a public-private mix has the most likely chance of becoming reality, according to the report, which will be presented to members of Congress Oct. 26.
The commission did not analyze the presidential candidates individual reform proposals but will do so in a report to be released in January 2008 that will include cost estimates, Collins said.
The commission recommends that consumers retain their ability to choose providers, and that broad groups of individuals be pooled together to spread coverage risk, as in Massachusetts universal coverage scheme. And the commission advocates shared responsibility, where employers, insurers, individuals and providers all contribute. I think shared responsibility would span the players in the system right now, Collins said.
But achieving that balance among a multitude of stakeholders with competing interests isnt easy, as evidenced in Californias efforts to extend coverage to its 6.7 million uninsured, Collins said.
Just this past week, labor and consumer groups launched an aggressive opposition campaign to Schwarzeneggers $14 billion healthcare reform proposal. Schwarzenegger wants to require Californians to carry health insurance and employers to pay up to 4% of payroll toward healthcare. The California Labor Federation, Consumers Union and other groups said this approach puts too much of an onus on individuals while not doing enough to control costs or require employers to shoulder a reasonable share of costs.