John Kitzhaber: The Health Care Crisis
At We Can Do Better, the website of The Archimedes Movement, former Oregon governor John Kitzhaber has posted an open letter to President Obama.
Dear President Obama,
It is increasingly clear that simply trying to get all Americans access to health insurance will not result in better health for Americans or reasonable health care costs. Without simultaneously having a public debate about what we are buying with our health care dollars and how the delivery system is structured, we will not solve the nation’s health care crisis. ...
Here is the framework for a new health care system proposed by the Archimedes Movement.
* We cannot solve the health care crisis by simply giving everyone insurance coverage (i.e. this is not just an insurance problem).
* We are all in this together and have challenged the whole concept of “categorical eligibility.”
* All Americans should be eligible for and have timely access to effective treatment for at least the same set of essential health conditions (“core benefit”)
* The core benefit should be portable and not tied to employment.
* In terms of financing, we believe the first emphasis should be on the public resources already being spent on health care. We are not trying to dictate what people do with their private after-tax dollars, but rather to ensure that public resources are spent in a way that is equitable, efficient and effective in producing health.
* Market competition should be based on cost, quality and outcomes, not the avoidance of risk.
* We must explicitly recognize the reality of fiscal limits and that we cannot purchase everything for everyone.
* We must acknowledge the inevitability of at least a two-tiered system; that people with more disposable income will always be able to purchase more than people with fewer resources. People should be able to purchase additional services that may not be covered in the core benefit. The challenge is to ensure that the core benefit (the “floor”) is adequate to provide for the health of all Americans.
* All medical interventions are not of equal value and effectiveness in producing health, and therefore a prioritization process must be established to decide what will be financed with the public resources.
* Individuals should be more directly involved in their own health care treatment decisions.
* It is important to promote healthy behaviors through strategies that focus on both individual choices (responsibility) and environmental influences.
* Co-payments should be used not simply to shift costs to individuals, but rather to influence individual behavior by placing lower co-payments (or no co-payments) for highly effective procedures backed by good scientific evidence and higher co-payments on lower priority interventions.
Hat tip: Dave Pollard
