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423 Guest editorial TWELVE PRINCIPLES FOR NATIONAL HEALTH INSURANCE REFORM HON. JOHN CONYERS, Jr. Chairman Committee on Government Operations U.S. Congress Washington, DC 20515 America faces three major challenges in reforming our health care system: how to provide comprehensive coverage to all of our citizens; how to stem the rising costs that are bankrupting families and businesses; and how to maintain our high quality of care. Winning broad support for major changes to our health care system will be difficult. The silence from President Bush over the last three years has been deafening. Only the 1992 election has roused him from his slumber. His proposal to use tax credits to help the uninsured buy health insurance is a fraud. Not only would it cost enormous sums of money that we would not have to spend under alternative plans, but it would do little to contain escalating health costs. Major financial interests—insurance companies, the doctors' lobby, drug companies, hospitals—are at stake in the debate over health care reform. Health care was a $738 billion industry in 1991, and accounts for one outof seven dollars spent in the economy.1 A medical-industrial complex controls more than 200 political action committees (PACs). Together, they have contributed $60 million to influence Congressional elections since 1980.2 The interests of these PACs often have little to do with the interests of consumer«—seniors, labor, small business, and families. Over the last year, I have spent considerable time meeting constituents, speaking with physicians, visiting hospitals, and holding Government Operations Committee hearings in Detroit and Washington on the health care problem . I also commissioned a major study by the General Accounting Office Journal of Health Care for the Poor and Underserved, Vol. 2, No. 4, Spring 1992 424_________________________________________________________ (GAO), the nonpartisan research arm of Congress, entitled Canadian Health Insurance: Lessons for the United States.3 Based on this work, I have identified 12 principles for reform: 1. Universal and comprehensive coverage Thirty-five million Americans lack health insurance; tens of millions of others are underinsured and only an illness away from bankruptcy.4 It should be a right as an American to be insured no matter what your income level or medical condition. Physician services and inpatient and outpatient hospital care for medically necessary services should be covered. Basic coverage for prescription drugs, dental care, mental health, and substance abuse treatment must be included. Families should also be free of the concern of the cost of longterm care. 2. No co-payments or deductibles Co-payments, deductibles, and extra billings are costly for people of moderate or limited income. Even minor charges discourage too many from getting preventive care (when the cost of care is much lower than when an illness is in an advanced stage) or from getting any care at all. They also bankrupt more and more families. 3. Government-financed insurance with free choice of provider Currently, the U.S. has 1,200 different insurance companies, in addition to the Medicaid and Medicare programs, that provide insurance to Americans. These many different policies result in an avalanche of paper for hospitals, doctors, consumers, and employers. All told, 24 percent of all health care spending goes to administrative overhead.3 By consolidating payments to health care providers under a single payer for each state—the state government —large administrative savings can be achieved and strong cost containment pursued. Consumers would still be free to choose their private, nonprofit, or public-sector physicians and hospitals. 4. Reduced paperwork The GAO report found that if the U.S. were to adopt a Canadian-style national health insurance program, the reduced paperwork would save $67 billion per year (not to mention the savings in aggravation).3 5. No new spending We spend far more per person for health care than do other major industrialized nations, yet they insure all of their citizens. The GAO study found that the $67 billion in paperwork savings would be more than enough to insure all Americans who lack coverage, and would eliminate co-payments and deductibles for everyone else who is presently insured.3 ___________________________________________________________425 6. Mandatory cost containment Health care costs are expected to increase by 14...


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