Health Care for All

The need for health care reform is well-known and, to most Americans, indisputable.  Numerous statistics and an endless trove of real-life stories document the need for bold health care reform.  This section provides four sets of policies to help state legislators and advocates build proposals and political strategies to challenge the self-interests of the health care industry and successfully move health care reform:

• Affordable, Quality Health Care for All
• Strategies to Extend Coverage to Uninsured
• Improve Quality and Cut Health Care Costs
• Stop Health Care Industry Profiteering

The cost of health care is the primary reason at least 47 million Americans lack coverage and at least 25 million more are under-insured, meaning their insurance does not shield them from high health care costs.  From 2002 to 2007, family insurance premiums rose 78% while inflation rose 17% and wages a mere 19%.  Both employers and employees are feeling the squeeze.  

Failure to create a coordinated and user-friendly health care system that provides necessary coverage for all Americans has left us with the endemic health care costs and wasteful spending that define our disjointed health care system.  For instance, a staggering 78% of all health care costs are for people with chronic conditions like diabetes, heart disease, and depression - costs which could be reduced with effective management and disease prevention.

Americans Want Reform:  Polls show that Americans want a better, more coordinated health care system that is affordable and easily navigable.  Voters consistently rank health care as one of the top three problems facing the country, along with the economy and the War in Iraq, according to the Kaiser Family Foundation.  But, an April 2008 Kaiser poll shows that voter concerns about health care run even deeper.  Health care consistently ranks as a top economic concern as well, increasing the prominence of health care as a key electoral issue in 2008.  Voters are even willing to pay more in taxes for a system that covers all Americans.  A 2007 New York Times/CBS poll found that 60% of US residents would pay higher taxes to ensure everyone has access to health insurance.

Building the Political Will to Act:  In many respects, we already know how to make health care in America work for everyone.  We have the justification and ideas for reform-the roadblocks are short-sighted political agendas and industry special interests. 

As states increasingly consider comprehensive reforms to achieve quality and affordable health care for all, progressive legislators and advocates must strengthen the public's will and voice calling for bold reform.  Knowing the facts and figures about health care in America is important, but statistics aren't enough to convince skeptical voters. Extensive public opinion research funded by Families USA, the Herndon Alliance, and AARP has yielded messages that progressives can use to expand the base of support for bold reform and counter the industry's tired but effective attacks against reform.   

Progressives need to appeal to voters' values and their anger at how our system functions.  Voters want control, choice of doctors, and peace of mind from high health care costs; and they are angry at insurance and prescription drug companies for putting profits before people. Tapping into these values will help ensure strong voter support for progressive legislators and progressive health care reform.

A Program for Health Care for All:  This document provides four sets of policies to help state legislators and advocates build proposals and political strategies to challenge the self-interests of the health care industry and successfully move health care reform:

• Affordable, Quality Health Care for All: Comprehensive health care reform proposals will vary across states - each with their own rules, regulations, and health care needs - but there are key elements which all comprehensive initiatives should include. Reform must address the three pillars of health care - cost, quality, and access. For instance, reducing the growth of health care costs is the only sustainable way to expand coverage to all residents.

• Strategies to Extend Coverage: The over-75 million Americans who lack insurance or are under-insured can't afford to wait for comprehensive reform. There are numerous steps states can take to expand access to coverage, from expanding Medicaid and drawing down additional federal dollars, to covering all children through the federal State Children's Health Insurance Program (SCHIP), to public/private programs helping residents afford quality coverage. Many believe these incremental steps can help build the base of support for broader reform, particularly as you build programs into the middle class.

• Stopping Industry Profiteering - Value for Your Health Care Dollar: The health care industry, notably insurers, drug companies, and hospitals, spend millions of dollars opposing sensible reforms and consumer protections that threaten their profits. Yet, the public, who believe the industry puts profits ahead of people, is largely supportive of measures to bring fairness and accountability to the industry. States have numerous options to make sure more of our premiums and tax dollars are going to medical care rather than profits and inefficiency. Putting the industry on the political defensive highlights their self-interest in opposing change and will help bolster the public's support for reform.

• Improving Quality and Cutting Unnecessary Costs: Improving quality will help reduce costs. The Institute of Medicine estimates medical errors cost $17 billion to $29 billion each year, resulting in an estimated195,000 patient deathseach year. Absent comprehensive reform, states can take numerous steps to improve the quality of health care, such as "pay for performance" and support chronic care management programs. Importantly, lawmakers need to place extra emphasis on reducing health disparities, as people of color and low income communities are especially impacted by the problems of our health care system.

The State Role in Health Care Reform:  We need health care reform by the federal government, but the importance of state reform to lasting change cannot be overstated. State legislators can both address key needs of their states and contribute to national momentum by articulating the models, practices, and standards that any national reform should have.  For example, the federal SCHIP, enacted in 1997, came out of earlier state efforts to expand publicly-sponsored health care programs for children.  Another example is health insurance regulation. States can ensure that any national health care reform includes strong protections for consumers and small businesses by enacting protections at the state level.  Congress is more likely to follow the lead of the states than to pre-empt established standards.  

Furthermore, a key strategy to prevent the rightwing from blocking reform at the federal level is to send a clear message that state progressives will make sure reform happens, either as a patchwork of state reforms or, ideally, a more integrated national reform built in collaboration with the states.  States pursuing reform sends a clear message that corporate interests cannot block good public policy by only playing spoilers at the federal level.