Policy Forums

Health Insurance for All Americans
Executive Summary

Mary Grealy of the Healthcare Leadership Council makes a point.

Forum I

November 13-15, 2006
Knoxville, Tenn.
Slides of final rankings of principles by participants (PDF)
Agenda

A group of about 30 national leaders representing business, health care, health plans, government, public policy and patient advocacy assembled to address how to provide health care coverage to the 46 million Americans — including 9 million children — who are uninsured.

Participants agreed that the issue must be addressed comprehensively — not incrementally — and considered within the entire framework of health care reform. Forum participants reached this common vision for change:

"All Americans will have health insurance and access to basic health care — regardless of their ability to pay — without endangering individual, family or societal economic security. The health care system will be patient-centered — affordable, sustainable, transparent and simple to navigate, with complex information translated so that consumers are able to be partners in all aspects of their care."

Action Principles

Forum participants spent the majority of the meeting proposing, debating and ranking action principles — broadly agreed upon fundamentals that will contribute to the formation of public policy and produce positive change. In the end, the group envisioned several ways to move toward comprehensive insurance coverage:

• Redefine the employers' role in providing health insurance
  
• Require individual ownership of health insurance, with sliding-scale subsidies for people with lower incomes
  
• Create an essential package of health care benefits, with the ability to purchase more services
  
• Develop a model of shared responsibility

Because of time constraints and differing perspectives, several more tactical ideas emerged that didn't receive full discussion or endorsement. See divergence points.

Redefine the employers' role in providing health insurance
Most participants agreed that individuals — not employers — should be accountable for having health insurance, similar to auto insurance standards currently in place in our country. Individual ownership allows for portability, accessibility and freedom to choose plans and providers.

The group endorsed a new role for employers: financing a portion of health care expenses (perhaps by providing employees with a stipend to offset premium costs) and promoting employee wellness in the workplace.

The participants also discussed that making this change may require reforms to the way health insurance is treated for income tax purposes. The current tax system provides favorable tax treatment to employer-provided insurance, and the tax subsidy is greatest for higher income workers.

Require individual ownership of health insurance, with sliding-scale subsidies for people with lower incomes
The group generally rejected a government-run single payer system, but expressed affinity toward the idea of individuals purchasing health insurance from organized purchasing pools, with the government providing subsidies for lower-income Americans. This is a system in which all would participate, regardless of financial resources, and the amount people pay would be dependent upon their ability to pay.

Some attendees noted that moving to individual ownership of insurance would, over time, allow citizens to keep their own insurance throughout their lifetimes, and eventually could eliminate the need for Medicare, Medicaid and other government-run programs. This would also create a stronger incentive for insurers to cover preventive care for younger individuals, knowing that savings would result in the long run.

The attendees also recommended covering the uninsured without spending more money on health care, which already consumes 16 percent of the gross domestic product. The group felt this could be accomplished through wide-sweeping reform and savings from eliminating inefficiency.

Create an essential package of health care benefits, with the ability to purchase more services
Attendees concurred that an essential package of health care services may include primary care, preventive care and coordination of care. They emphasized that services in the basic package must be rigorously evaluated from both a scientific and actuarial standpoint, suggesting that an independent health board (shielded from the political process) could help formulate the offering. The group also agreed that Americans should be given the option of buying additional health care services beyond the covered essential services.

"Consumers know more about what they need than a bureaucracy does."

- Grace-Marie Turner, Galen Institute

Develop a model of shared responsibility
Individuals, providers, businesses and the government must be engaged and active participants in a health care system that puts the needs of the patient first. As providers and the government make this shift — educating patients about their conditions, simplifying complex administrative processes, and building transparent, understandable reporting structures — patients must become partners in their health care by following treatment plans, making healthy lifestyle choices and taking responsibility for all aspects of their health.

Carefully plan the transition
To make these suggested changes would require further consensus-building among stakeholders and a carefully constructed action plan to manage the transition to a new system. Participants emphasized that current insurance models should not be dismantled until a new system is in place.

Next steps
These proposals — along with others developed during the remaining three forums — will be reviewed at the Mayo Clinic Health Policy Center's 2nd National Symposium on Health Care Reform in early 2008. Additional programs — town hall meetings, or summits with national policy and business leaders — may be held to coalesce and further define these principles and build support for comprehensive reform. The ultimate goal is to engage a cross-section of stakeholders and build a public mandate for change based upon common principles.

Divergence Points

During the forum, participants reached consensus on several principles for insuring all Americans. Because of time constraints and differing perspectives, several more tactical ideas emerged that didn't receive full discussion or endorsement:

• The group did not reach consensus on how to reform the tax structure to allow for coverage of the uninsured.
  
• Although attendees agreed that health insurance subsidies should be given to lower-income people, there was no consensus on approach (i.e., voucher, tax credit or other mechanism).
  
• There was little discussion on insurance coverage for long-term care.
  
• Although the group debated various mechanisms to finance care for the uninsured (i.e. value-added taxes), there was no agreed-upon approach.
  
• Participants concurred that an independent health board could help formulate an evidence-based package of essential services, but didn't come to terms about the board's make-up or method of accountability.