NCHC Writer
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JANUARY 26, 1998

      Each of us has been asked to share our organization’s views on the state of our health care system and the steps necessary to resolve its serious and growing problems.

      Our Coalition is the nation’s largest and most broadly representative, non-partisan health care alliance. Presidents Carter and Ford honor us as co-chairs and our 93 members represent or employ over 100 million Americans. Our Coalition includes all three of our nation’s major religious faiths, and our concerns include the ethical and moral problems associated with a troubled health system, as well as the issues of cost and coverage.

      Today’s forum occurs as the nation, the Congress and the administration prepare for a major debate on health system and Medicare reforms and a Consumer Bill of Rights. We commend those who are working on these issues, but we are concerned that as a nation we have failed to learn from the mistakes of the past and continue to adopt patchwork reforms to deal with the symptoms instead of with our underlying problems.

      The debate to this point on a variety of partial reforms and a Consumer Bill of Rights constitutes a graphic case in point. Let me explain. Recently, our Coalition released a series of studies to serve as a “reality check” on the nation’s three major health care problems. They show that the health care crisis, acknowledged by both Presidential candidates in ’92 is not only still with us, but is in fact growing worse and that the problems of poor quality, rising costs, and decreasing coverage are interrelated and therefore cannot be dealt with in isolation from each other.

      Despite the explosion in growth of managed care, our costs continue to rise at twice the rate of inflation. Today’s one trillion-dollar system will double in cost to two trillion dollars in the next decade. This will adversely impact our economy, the deficit, the nation’s small businesses and the middle class’s standard of living. A major factor increasing costs is poor quality and the resultant extensive waste and poor outcomes.

      Largely due to rising costs, our safety nets, including the employment-based health insurance system are deteriorating , and the number of uninsured, mostly middle class working Americans is increasing at a rate of over 1 million each year. At this moment there are over 40 million Americans without any health insurance and an equal number of underinsured. We know that in the absence of insurance coverage, or cross subsidies, it is increasingly difficult to get needed care. The result is that health outcomes and quality suffer. In fact, studies show that, other than aging, the biggest risk factor associated with a poor outcome or death is the lack of health insurance. Whether or not you receive timely and needed care (determined largely by whether you have insurance) can determine whether you live or die.

      It’s a vicious cycle. In the absence of quality you cannot contain costs, without cost containment you cannot assure or afford universal coverage, and without universal coverage, you cannot assure quality.

      In light of this we have long considered quality a central problem, and quality in our definition is not just choice and appeals processes. Quality is doing the right thing at the right time in the right place with the optimal outcome.

      The causes of our quality concerns include truly massive and indefensible regional variations in medical care, high error rates, gaps in our knowledge and databases, and inadequate technology assessments. Health professionals today work in flawed systems with inadequate quality controls and data. This leads to errors and unnecessary harm. Harvard studies have concluded that medical negligence and malpractice constitute the nation’s “hidden epidemic.”

      Because of these system deficiencies and the resultant misuse of technologies, hundreds of billions of dollars are wasted, millions are injured and tens of thousands die unnecessarily each year. Quality experts note that no other industry would be allowed to operate even a day with a quality and safety record such as this. These quality problems existed long before the advent of managed care, and are found even in the nation’s preeminent institutions.

      Despite the seriousness of these problems, our nation has no integrated system for assessing or assuring quality. Nor do we have in place the necessary standard setting mechanisms. This makes it very difficult for health professionals to practice as well as they would like, or as well as the American people would like.

      What steps are needed to deal with these interrelated problems? First, we believe we have to recognize that neither the market, managed care, medical savings accounts, voluntary action nor the private sector alone will be able to correct problems of this magnitude. We will need a major national commitment to universal coverage and cost containment, coupled with a quality “moonshot,” if you will, with the resources necessary to set priorities and goals, fund necessary research and develop the needed systems and data.

      Second, the nation needs to proceed in a “no-fault” manner to establish a publicly accountable quality assurance system that will bring together the strengths of the public and private sectors, with the resources and authority necessary to do the job.

      Finally, we do need adequate consumer safeguards including a sound “Bill of Rights.” But in our view, there is no more fundamental consumer right than to be assured that care is evidence based, effectively delivered and available to all when they need it. Absent these elements, no Bill of Rights will fulfill its promises or meet the public’s needs. But more importantly, costs will not be contained and the vicious cycle of increasing costs and cost shifting, decreasing coverage and the resultant poor quality will continue. And without universal coverage, meaningful competition will not be achieved.

      Improved quality, effective cost containment and universal coverage are the bedrocks on which a better and more ethically defensible system must rest. All reforms should be designed to achieve and judged against these bedrock principles.

      Is there hope? Absolutely. These are not partisan principles, and, working in a bi-partisan fashion with the administration and the Congress , we believe they can be and indeed must be achieved. Can we get there in steps? Yes we can. But the steps have to be designed with the essential principles in mind. This is the task ahead for all of us.