Five Key Principles
One reason, among others, the Clinton health care initiative failed was the legislation was crafted by experts behind closed doors in the White House. Stakeholders, especially potential allies in Congress, had no say and no ownership of the proposal.
The Obama administration doesn't want to make the same mistake and is inviting stakeholders to participate in the process. But they should insist that the participation conforms to clear principles. This is because a comprehensive health care policy that provides affordable universal care requires taking account of interrelated factors. You can't achieve the goal without tackling all of them.
The Obama administration plans to present eight principles. They should include the five agreed to by the bi-partisan National Coalition on Health Care, a group of 75 companies, unions, pension funds, health care provider organizations, patient advocacy organizations, religious organizations and the AARP. In 2003, together with Henry Simmons, the coalition's president and Mark Goldberg, its vice president, I facilitated a year-long process in which the members arrived at a consensus on interconnected specifications for a comprehensive health care system based on these five principles: health care coverage for all, cost management, improvement of health care quality and safety, equitable financing, and simplified administration.
These specifications allow for alternative solutions, and the White House should be flexible about how the specs are met. But partial plans that don't include the five principles can produce unanticipated negative results. For example, expanded care without improvement in quality and cost control can overload a health system that delivers worse care with huge increases in cost. However, with universal insurance coverage , quality and cost control, hospitals would receive payment for care they now provide with little or no compensation.
Improving our health care system is a long-term project. There is a huge variability in treatments and costs for the same health problems. But we also have some of the best medical facilities in the world, and legislation should reward those providers who learn from them. There are different ways of guaranteeing all Americans health care. But to make sure it is affordable quality care, the Obama administration must make sure that legislators meet all the specs.
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