What Are the Next Steps for Making Health-Care Reform Happen?

ByABC News

Oct. 20, 2006 — -- ABC News has asked a panel of experts five questions about what it would take to fix the U.S. health-care system, and we'll post one question and answer every day this week.

The experts include physicians, academics and consumer advocates.

Below is the fifth and final batch of responses they've brought to this five-part series -- some surprising, some simple.

Dr. Alan Garber

Director, Center for Health Policy, Stanford University

The federal government and private organizations should provide information to help the public learn more about which health care is truly valuable. As health-care consumers, we need to recognize what our care really costs. We can no longer pretend that costs that we pay indirectly as part of our health-insurance premiums are paid by someone else with deep pockets.

And we need a national dialogue about how we should spend our tax dollars -- how much on health care, and how much on other needs like roads, public safety and schools. We face real challenges that require decisive action, but that action should be well-informed and well-planned.

Dr. David Gratzer

Senior fellow at the Manhattan Institute, and a licensed physician in the United States and Canada. Gratzer wrote "The Cure: How Capitalism Can Save American Health Care"

Capitalism: Make health insurance more like other types of insurance; promote competition; reform Medicaid, using welfare reform as a template; revisit Medicare reform; address the cost of prescription drugs by reconsidering the size and scope of the [Food and Drug Administration].

Regina Herzlinger

Senior Fellow at the Manhattan Institute and the Nancy R. McPherson professor of business administration at the Harvard Business School

Require employers who pay for health insurance to give the money directly to their employees. Make the transfer of the money fair, tax-wise. Require everybody to buy health insurance. Require all health-service providers to have their quality measured and the results posted publicly. Risk-adjust the transfer so that doctors get more when they see a sick patient than a well one.

Dr. Joanne Lynn

Physician and researcher with the Department of Health and Human Services Office of Clinical Standards and Quality at the Centers for Medicare and Medicaid Services

Much is happening already -- demonstration projects under the Centers for Medicare and Medicaid Services (CMS); research spearheaded by the Assistant Secretary for Planning and Evaluation (ASPE) in the U.S. Department of Health and Human Services and by the Agency for Healthcare Research and Quality (AHRQ); state initiatives using Medicaid; private initiatives in long-term care and in novel care delivery arrangements; and comprehensive coordinated services in the Veterans Health System and some capitated delivery systems.

Everyone involved recognizes the urgency to find ways to deliver the fruits of modern medical care while also being equitable and efficient. The U.S. will need to maintain a commitment to ongoing reforms and growing insight for some years in order to achieve a care system that gets the right services to every person at the right time -- every time.

Lisa McGiffert

Senior policy analyst at Consumers Union, publisher of Consumer Reports

Though there's broad agreement among Americans that our health-care system needs to change, we do not yet agree on how to do it. It's time to start a serious conversation. Any solution must be measured against some basic agreements: that it covers everyone, assures a high-quality of care, contains costs, finances care fairly, is publicly accountable, and guarantees the right to choose where we go for health care and who will provide it.

A lot of people make a lot of money on health care in America. They have direct access to our leaders and use their vast resources to influence public policy and public opinion whenever changes are proposed. We need strong voices to counter their influence.

Robert E. Moffit

Director, Center for Health Policy Studies, the Heritage Foundation

Two thoughts come to mind.

First, at the very least, Congress should enact an individual health care tax credit for individuals and families who do not or cannot get health insurance through the place of work. This would create a level playing field between employment and non-employment based health insurance, and resolves some of the glaring inequities in the health insurance markets that today penalize low income working people.

Second, state officials could transform their uncompensated care subsidies to hospitals and other health-care facilities into a pool for the funding of vouchers for low-income people without health coverage, as was done recently in Massachusetts.

Debra Ness

President, National Partnership for Women and Families

We need to put in place performance standards and collect data and share it with the public. That will help consumers make smart decisions about what doctor, what surgeon, what hospital to go to. Poor care and medical errors are costing lives every day. There is no time to waste.

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