High Voltage Shareware/high1.zip/high1/DIR23/HREPORT.ZIP/CHAPTER9.TXT

Text File | 1993-10-26 | 14KB | 298 lines

Chapter 9 -- RESPONSIBILITY



     "My husband and I are 59 and 63 years of age, so we are not
yet eligible for Medicare to help us...A brief summary of our
health insurance costs over the last 4 years are:

     1988- $3,578 with $500 deductible
     1990- $4,607 with $2,500 deductible
     1992- $10,500 with $2,000 deductible

"I have a pre-existing condition so I have to pay a penalty on
the rates.  Neither my husband nor myself, fortunately, has ever
had a claim of any kind...

"We do not want a 'free ride.'  We are more than willing to pay
our share, but these amounts are just too excessive."

M.M.
Joliet, Ill.
________________________

     Responsibility is central to every one of the principles of
the Health Security Act. As the President said in his address to
the Joint Session of Congress, "We need to restore a sense that
we're all in this together and that we all have a responsibility
to be a part of the solution."

     All those involved in providing health care will, for the
first time, share collective responsibility for the quality of
care patients receive, and for keeping patients healthy, not just
treating them once they're sick.  Health plans will have the
responsibility of keeping the costs of premiums reasonable --
there will be no more blank checks for health care. This newfound
imperative for responsible health care will mean a change in the
way some currently do business.

     For insurance companies, responsibility means no longer
denying people coverage if they get sick. For unscrupulous
medical companies and laboratories, responsibility means an end
to fraudulent billing practices. For lawyers, responsibility
means no more filing of frivolous lawsuits. "In short," as the
President said, "responsibility should apply to anybody who
abuses this system and drives up the cost for honest,
hard-working citizens and  undermines confidence in the honest,
gifted health care providers we have."

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Sidebar - Pg 78-79

Medical Malpractice

     Responsibility means bringing common sense to our medical
malpractice system.  Although experts believe that the direct
cost of malpractice accounts for less than two percent of our
spending on health care, reform of our existing system is badly
needed. We must work to remove the threat of lawsuits that leads
to so much "defensive medicine" and drives up costs for everyone.
We must free doctors to do what they do best -- care for patients
-- while protecting consumers at the same time. And we must take
steps to let lawyers who profit from huge settlements know that
they can no longer take advantage of the system.

     In an effort to end frivolous lawsuits and protect doctors,
the Health Security Act will change tort laws and develop new
alternatives to resolve patients' claims against providers before
they get to court. The Act will require those who believe they
have been the victims of malpractice to first submit their claims
to an out-of-court panel to resolve the dispute. If the patient
is still unsatisfied with the resolution, the case can be taken
to court, but only after obtaining a "certificate of merit," an
affidavit from another doctor stating that the patient has good
cause to pursue a claim.

The Act will also:

*  Limit attorneys' fees to one-third of an award, and allow
   states to impose even lower limits;
*  Allow damages to be paid over a period of time rather than all
   at once;
*  Prevent injured patients from gaming the system and getting
   paid twice for the same injury -- once by a doctor and a second
   time by a health or disability insurance plan; and
*  Promote progressive ideas such as a program in Maine that
   frees doctors from malpractice liability if they can demonstrate
   that they followed prescribed clinical practice guidelines.

     Taken together, these steps represent the first serious
national effort to take what has been learned in the states and
apply it on a national level. Once implemented, these steps will
help turn the incentives in our health care system right side up.
By restoring responsibility to our medical malpractice system, we
can also restore trust to the doctor-patient relationship which
lies at the heart of health care.

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     For employers -- both large and small -- responsibility
means following the lead of our nation's most successful
businesses and helping contribute to the health security of every
employee. For every American, responsibility means taking care of
your health, rejecting behaviors that drive up health costs, and
making a contribution to health coverage. "Responsibility," as
the President said, "isn't just about them. It's about you, it's
about me, it's about each of us."

Paying for Health Security

     Even though our nation spends nearly one of every seven
dollars on health care, tens of millions of American lack health
security.  More than 37 million Americans have no health
insurance.  More than 25 million Americans have inadequate
insurance -- so-called "bare bones" coverage or policies that
don't cover them when they need it most. And nearly every
American family -- even those with health insurance -- live with
the fear and the hard fact that only one pink slip, one seriously
ill relative, one misfortune could cost them a lifetime of
savings and even their independence and dignity.

     Providing all Americans health security will make our nation
stronger and bring down health care costs. In the short term, it
will take new funds to cover the uninsured and provide those who
are now covered with rock solid security and comprehensive
benefits.  The question is how we will pay and who will pay.

     The vast majority of funding for the Health Security Act
will continue to come from where it comes from today: employer
and employee contributions to the cost of health insurance. New
funding will be drawn from three primary sources:

*  Asking all employers and the 30 million Americans who work for
   them but do not have health coverage to contribute to their
   health care;
*  Increasing excise taxes on tobacco and requiring small
   contributions from large corporations who choose to form their
   own health alliance;
*  Limiting the growth in federal health care programs.

     These are the fairest and most workable sources to yield
sufficient money and guarantee health security to every American.

Expanding the Current Employer-Based System

     The principal way we pay to ensure health security for all
Americans is by building on our current system and asking all
employers and employees to take responsibility for paying for
health coverage.

     Today, nine out of ten Americans who get health coverage get
it through their employer. It's a system that works for the vast
majority of Americans. That's why the President rejected any kind
of broad-based tax to pay for a government-run system -- deciding
instead to leave our health care system rooted in the private
sector.
     Today, most employers and employees contribute to the cost
of health coverage, but not all do.  Thirty million Americans in
working families go without health coverage because they are not
covered by their employers.

     But these workers still get health care when they need it --
often the most expensive kind of health care in the most
expensive place: the emergency room. And the rest of us end up
paying the bills -- in higher premiums, higher taxes and inflated
hospital charges.

     This phenomenon -- what academics call "cost shifting" --
contributes to the high health care costs we all are forced to
pay.  This "cost-shifting" happens on every street in America
where you'll find a supermarket, a dry cleaner, or a gas station
that doesn't insure its workers. On the next block you'll find a
supermarket, dry cleaner, or a gas station that does insure its
employees. The businesses that insure pay higher premium costs
because they are forced to pick up the tab for their competitors
who are not paying.

     The Health Security Act asks those who aren't paying to pay
their fair share, lowering costs for the vast majority of
companies and individuals, who will no longer see their premiums
rise to pay for those without insurance.  We'll save $25 billion
by providing coverage to everyone, because the government will no
longer have to reimburse doctors and hospitals for the cost of
caring for the uninsured.

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Sidebar - Pg 82

HAWAII

A Model for Reform

     Only one state in America has asked all employers to
contribute to the cost of their employees' health care: Hawaii.
And it has been able to achieve near-universal coverage while
maintaining a thriving economy.

     In many ways, the Health Security Act echoes Hawaii's
experience. Hawaii passed a health reform plan in 1974 that
required all employers to contribute to their workers health
care. As part of the reform, Hawaii included special programs to
ease the burden for small businesses. The result? A greater
percentage of Hawaiians have health insurance, far more than in
any other state in the country. Health care costs are
significantly lower in Hawaii than elsewhere in the U.S. And only
2% of small firms have sought out a special program for small
businesses struggling to provide insurance.

     In fact, since Hawaii passed health reform, the unemployment
rate there has dropped to one of the lowest in the nation (2.8%
in 1991). Meanwhile, small business creation rates have remained
high (the number of employers grew almost 200% from 1970 to
1991).

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     While building on our current system ensures that 30 million
working Americans will receive health coverage, requiring
responsibility from all employers and employees does not alone
provide true health security.  Additional funding is needed to
protect small businesses, provide long-term care and prescription
drug coverage to older Americans, and ensure that no American --
including those who lose their jobs -- ever lose their health
coverage.

     To guarantee comprehensive benefits for all Americans, the
Health Security Act requires the second and third primary sources
of funding: a cigarette tax and corporate assessment, and savings
from slowing the growth of federal health care programs.


The Cigarette Tax and Corporate Assessment

     Cigarette taxes will increase by 75 cents a pack, raising
revenue for health reform, and ensuring that those who smoke pay
for the health costs that smoking causes. Higher tobacco prices
may also have a significant impact in preventing teenagers from
ever starting to smoke.

     In addition, large corporations that form their own
alliances will contribute to help support the backbone of our
health care system -- academic health centers, advanced medical
research, as well as other elements of our health care
infrastructure.  Asking large corporations to pay one percent of
their payroll will support those institutions that benefit every
American.


Slowing the Growth of Federal Health Care Programs

     The Health Security Act will also produce savings by slowing
the skyrocketing growth of government spending on health care
programs.  Over time, the Health Security Act will slow the rate
of growth in Medicare (the government program for seniors and the
disabled) and Medicaid (the program that provides health care to
the poor)  from three times the rate of inflation to roughly two
times the rate of inflation.

     Upper-income people who receive Medicare -- those
individuals who earn more than $100,000 per year -- will be asked
to pay a higher percentage of the cost of coverage than they do
today.

     People covered by Medicare will see an increase in their
benefits under the Health Security Act. Elderly and disabled
Americans will receive the prescription drug coverage they need,
and a new  long-term care program will provide options for home
and community-based care.

     Most Americans who now receive health care through Medicaid
will be part of the same system as other Americans, paying what
they can for their care but benefitting from discounts that make
coverage affordable.

     By controlling costs in both the public and private sector,
these savings avoid hurting privately insured people. Today,
doctors and hospitals often charge more to private patients to
make up for shortfalls in what they are paid to provide care to
people covered by Medicare and Medicaid.  The Health Security Act
slows the growth in federal health care programs as part of
fundamental reform that controls the cost of all health care.

     These are the three primary sources of private and
government funding that will help pay for health security for
every American -- full responsibility from businesses and
individuals, cigarette taxes and a small corporate assessment,
and a slowdown in the growth of Medicare and Medicaid.  This is a
conservative approach that doesn't count on the billions in cost
savings that can be achieved from the plan's new emphasis on
preventive care,  encouraging real competition among health
providers, and cracking down on health care fraud.  It is an
approach that asks responsibility of everyone. In return, it
guarantees every American comprehensive health benefits that can
never be taken away.