Specifications for Reform

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 The United States is in the midst of a major debate — a necessary debate — about the future of our health care system.

In 1993 and 1994, our nation had such a debate — in Congress, the press, and the polity — about a variety of proposals, from many quarters, for health care reform. Political leaders in both parties agreed that the problems confronting health care then — in particu-lar, rising costs and increasing numbers of Americans without health insurance — constituted a genuine crisis and warranted an urgent policy response. That debate ended without legislative action. The health care system was not reformed, its problems remained un-checked, and the sense of urgency that had animated and permeated the debate dissipated.

The system-wide problems that triggered an intense national debate more than a decade ago are larger now than ever. The growth of these problems has overwhelmed incremental measures meant to al-leviate them. If we needed comprehensive health care reform in 1993 and 1994 — and we did — we need it even more today.

The recommendations for comprehensive reform that you are about to read come not from a single organization or interest, not even from one sector of American society. They were developed, in a year of study and deliberations, by the National Coalition on Health Care, which brings together many interests and sectors. The Coalition is an organization of organizations — of roughly eighty of America’s large and small businesses, unions, civil rights and advocacy groups, health care providers, associations of religious congregations, pen-sion and health funds, insurers, and groups representing patients and consumers. Collectively, the Coalition is the nation’s largest and broadest alliance working for the achievement of comprehensive health care reform. Our members represent — as employees, mem-bers, or congregants — at least 150 million Americans. They speak for a cross-section — and a majority — of our population.

The organizations that belong to the Coalition are united by their commitment to the pursuit of five principles or goals for a reformed health care system:

• Health Care Coverage for All

• Cost Management

• Improvement of Health Care Quality and Safety

• Equitable Financing

• Simplified Administration.

The Coalition is rigorously non-partisan. Its honorary co-chairmen are former Presidents George H.W. Bush, and Jimmy Carter. Its co-chairmen are former Iowa Governor Robert D. Ray, a Republi-can, and former Pennsylvania Congressman Robert W. Edgar, a Democrat. Our members believe that an effective response to the crisis in American health care is urgently needed and that it will re-quire leadership from both political parties and a willingness to compromise across ideological, economic, and social divides.

It is in that spirit that we offer a series of interconnected specifica-tions for reform. This brief document does not describe one plan, one potential course of action. Instead, it sets out objectives for re-form, criteria by which alternative proposals can be assessed, and options for policymakers and the public to consider.

Our hope is that these specifications will help to further the national debate about how to build a better American health care system — and that they will help to embolden political leaders to act.

The specifications summarized here are tough, thorough, and ambi-tious. Our members have set aside their preconceptions and predis-positions in order to forge a consensus document. Individual mem-bers may have different first preferences on some of the items ad-dressed, but they recognize that for progress to be possible, a com-pelling national interest — in the assurance of excellent and afford-able health care for all Americans, in the creation of a health care system that can serve us all well in the decades to come — has to be given precedence over narrow self-interest. They are unified in be-lieving that these specifications represent a sound and sensible set of concepts and precepts for a public-private partnership to reform American health care.

That these recommendations were developed by such a diverse and large aggregation of powerful organizations — representing such a broad swath of our economy and society — should be heartening to those who had given up on the prospects for policy responses com-mensurate with the scope of the challenges we face. We should not be resigned to settling for small steps forward — not when the prob-lems of the health care system are growing by leaps and bounds.

We need systemic, and rapid, reform.

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