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Consensus on Health Care Begins to Emerge

A national fix for health care costs? It may not be that far off.
 
 

Expect a concerted effort to bring health care costs under control soon after the 2008 elections, no matter who succeeds President Bush in the White House. Momentum is growing, with such varied stakeholders as employers, unions, consumers, providers and insurers agreeing that health costs are still rising too quickly, even if they disagree on precisely how to bring them under control.

Businesses are pressing especially hard to ease what they view as a big burden. Firms are tired of premiums pushed ever higher to cover the cost of care for the uninsured -- now over 45 million and growing. Big U.S. companies pay more than do rivals in Europe and Asia, making it harder to compete in global markets.

Consumers are also clamoring for a fix. Even those who currently have health coverage worry about being able to find it or afford it in the future. That insecurity is a big change from 1994, when the Clinton administration's effort ran into a storm of opposition.

Plus states are adopting their own plans, adding to the pressure on employers, who prefer a national approach to a hodgepodge of state rules.

What will a national plan look like? Details will depend on results in states already implementing programs. Massachusetts has begun one, and California is getting close. The makeup of Congress and the winner of the presidency will also have an influence.

Among the likely key components:

  • Cost containment, with a focus on prevention, disease management, electronic records, promotion of healthy lifestyles and, later, reimbursement rates based on the effectiveness of treatments.
  • Universal coverage, probably phased in, starting with children. The poorest will get free care. The working poor will receive subsidies. The Massachusetts plan aids families with incomes up to triple the poverty level.
  • A shared burden. Companies will have to offer and help pay for health coverage, or else pay fees to help subsidize coverage for the needy.
  • Exemptions for small firms with few workers. Individuals who can afford to buy coverage will likely either be required to do so or have to pay a fee.
  • Employer-based coverage. Any new health plan will be built on the system that exists now.

Neither of the extremes -- establishing a new, government-run plan or forcing consumers to buy individually on the open market -- has much chance of receiving serious attention in Congress.

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