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Goal for health reform? Universal coverage


In providing a health care reform prescription, a panel of witnesses who testified last week before the Senate Finance Committee got it exactly right.

Their message to legislators was: agree on a package to achieve universal coverage, but do so without turning the current financing and delivery system upside down.

To do otherwise creates winners and losers, said one of the panelists, Stuart Altman, a professor at Brandeis University. Because they have a lot to lose, the losers form alliances with other "losers" to derail reform initiatives, he said.

For example, look back to the 1990s when President Clinton pushed for enactment of a major health care reform package that would have replaced the employment-based system of coverage delivered through commercial insurers with a government-controlled system.

In part, the plan failed due to opposition from insurers, which would have been frozen out, and employers, which believed they could do better than the government in holding down costs.

Now, policymakers are considering reform more realistically, looking to retain the current system, but eliminating its most pressing problem: the lack of universal coverage. Universal coverage can be achieved through a variety of relatively easy steps, including premium subsidies for lower-income, uninsured individuals.

The cost might not even be that great, considering that expanded coverage would mean people would receive treatment sooner--reducing the likelihood of minor medical problems mushrooming into conditions that are expensive to treat--and in lower-cost settings, such as doctors' offices rather than emergency rooms.

Policymakers should keep their eyes on one goal: universal coverage.