Nov. 15, 2007 -- Health insurance for everyone should be the top health care priority for the next president, according to recommendations issued Thursday by a group of the nation's top health policy experts.
The experts are calling on the next president to push for coverage of all the 47 million Americans who now lack it. They should also move to overhaul how doctors, hospitals, and patients handle medical treatment in the $2 trillion-per-year health system, the group says.
If that sounds like a huge job, it is. Most observers believe that "universal" health coverage will take many years to achieve and will cost tens of billions of dollars. Some candidates have said they want to try to lower health care costs first before directly tackling the numbers of uninsured.
"What we're really saying is none of the candidates go far enough," says Karen Davis, president of the Commonwealth Fund, a nonprofit health policy think tank that convened the group of 16 experts.
Thursday's report calls for universal coverage along with an overhaul of health care delivery and financing. That could mean that Washington will have to come up with a lot of money to pay for expanded coverage even before any savings kick in from reforms.
"You and I both now that has been the huge issue here," says James J. Mongan, MD, the chairman of the Commonwealth Fund commission on a high-performance health system.
The group states that hospitals, insurance companies, and doctors should also have to publicly report how effective they are in treating and preventing disease.
Other recommendations include improving the management of chronic diseases like diabetes and increasing patients' role in their health decisions. Experts say they have not yet decided specifically how the next president and Congress should achieve the giant overhaul.
The Cost Problem
One issue plaguing policy makers now is how exactly to start to lower costs. Candidates have proposed a range of policies, including increasing the use of information technology and electronic medical records.
But Peter Orzsag, head of the Congressional Budget Office, told reporters earlier this week that most candidates' cost-cutting policies lack evidence that they'll actually work.
And that's only because very little research comparing different technologies or treatments for cost-effectiveness has ever been done.
Commission member Michael Chernew tells WebMD that the only sure-fire cost-cutting measures would prove too unpopular to use. They include cutting doctors' fees or capping medical spending at a certain fixed level.
"The candidates haven't proposed the things we know will save money, because the things we know will save money would hurt people," says Chernew, a Harvard University economist who is also a member of the Congressional Budget Office's health care advisory panel.
Mongon acknowledges that policy makers, including the next president, need a lot more evidence before they will really know how to cut costs.
"That's not an excuse to not try," he says.