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Joint Principles for a Reformed American Health Care System

The United States invests a higher proportion of its total wealth on health care than any other industrialized nation, but it fails to guarantee that all Americans benefit from that extraordinary investment. People without health insurance coverage face a significant risk not only to their health, but to the security of their families and their economic well-being.

The lack of universal health insurance coverage is also a major competitive burden on American employers who provide health care for their employees. These employers pay not only for the health care of their own employees and retirees, but a substantial portion of the costs for providing uncompensated care to the uninsured. When public health care programs are inadequately funded, this burden too is shifted to private payers and health providers. The result is that American businesses must compete against businesses in other nations that have established more rational public, private or mixed health care systems where costs are allocated more rationally across the entire economy, and not disproportionately to employers who provide health insurance coverage.

At the same time, despite rapid growth in health care spending, the extent of coverage that is available to those who do have insurance is eroding and the quality of care they receive is too often below the standards achievable by adopting best practices. Health care organizations and health care workers naturally place a high degree of importance on universal access to health care. This interest is practical, professional, and rooted in our core values. We want to be sure that the people we care for every day can get the care they need, when they need it. Our pragmatism leads us to recognize that a fair system of financing is essential to sustain the health of the health care system. Any solution to the problem of the uninsured must be built on a foundation of broad agreement and participation by all stakeholders – including those with different ideologies and points of view.

We believe the first step toward universal access to health care is to develop consensus on a core set of principles for a reformed health system, and that such a consensus is achievable. Any meaningful, viable proposal for health care reform must:
  1. Ensure universal health care coverage for all Americans.
  2. Improve the quality and efficiency of health care services by adopting clinical best practices and promoting organized systems of care.
  3. Establish a stable, equitable, broad-based, and predictable health care financing system.
  4. Promote affordability and address rising health care costs by advancing opportunities to achieve the greatest value for our health care dollars.
  5. Provide meaningful individual choice of providers and plans while promoting preventive care, protecting consumers from the costs of major illnesses, and improving the management of chronic conditions.
  6. Achieve greater reliability in health care coverage, including improved portability of coverage and continuity of care.
A solution to our health care crisis must first and foremost provide coverage for all Americans. Despite being the richest country in the world, and the one that spends the highest proportion of its wealth on health care services, the United States is the only industrialized country in the world that does not provide health care coverage for all of its residents. This is unacceptable.

Quality Improvement

Health care providers and health care systems should be encouraged to invest in programs to improve the quality of the health care services they provide. Payment systems should encourage the adoption of electronic medical records and provider support systems, and facilitate competition among and consumer choice of providers on the basis of reliable and accurate quality measures. The health care system should encourage a culture of quality and patient safety, helping providers avoid errors and bad outcomes, rather than accepting them as inevitable.

Stable and Predictable Financing

A reformed health care system is only as good as the social contract its financing system is built on. Health care system financing should be as broad-based as possible to spread the cost of care across all sectors of the economy. The United States has a history of a mixed public and private financing of health care services, with employers, taxpayers and individuals all sharing responsibility for financing health care coverage. It is important that all of these shared burdens be examined and balanced, and that requirements for public financing be credible and sustainable over the long term.

Affordability and Value

The increasing cost of health insurance, health care services, and prescription drugs and medical devices threatens existing health care coverage and makes it difficult to establish a sustainable system of universal coverage. A reformed system should encourage value purchasing by comparing the effectiveness of different therapies for the same conditions, educating providers about the relative health value of different interventions, and assuring that government policies do not have the unintended effect of increasing costs without providing commensurate value.

Meaningful Choices

Coverage for every American should provide protection against the costs of catastrophic illnesses, promote ready access to preventive services, and enable patients to manage chronic conditions. Individuals should also have options to obtain more comprehensive coverage. In addition, no one should be forced into a health care setting with which they are dissatisfied. Individual choices in selecting health care providers and plans should be supported by a system that reports on the comparative clinical quality and patient satisfaction levels achieved by providers, and patients should have access to the full range of delivery system options. A reformed system should encourage the continued development of more integrated health care delivery systems, which can provide greater levels of quality and convenience at an affordable cost.

Reliability, Portability and Continuity

Life is uncertain, but health insurance should not add to that uncertainty. People should not have to organize their lives around their health care coverage. A reformed health care system should assure individuals that their health care coverage will remain reasonably stable over time. Coverage should be more readily portable from job-to-job, and those who move out of the workforce should have continued access to coverage. Similarly, changes in family status or income should not lead to disruptions in access to care.