BAUCUS PRINCIPLES: THE VISION FOR OUR HEALTH CARE SYSTEM

While there may be differences of opinion on the solutions, most Americans agree on the principles that health reform should embrace. These principles form the foundation of this Call to Action.

There is widespread agreement that every American should have health coverage. This does not mean that a government program should provide the coverage. Such a system may not be viable in a country that values individuality, choice, and a preference for market-based solutions. A mix of public and private solutions must be found to keep our system from leaving millions of Americans behind.

There is also agreement that our health care system must do a better job of containing costs. Any serious health reform proposal must include policies that will slow the rate of growth in health spending over time. The sustainability of the nation's public programs, America's businesses -- and the economy -- depend on it. Along with efforts to rein in health spending, the quality of care must improve, and payment systems should better align incentives to foster a focus on providing better care rather than more care. Our system must also encourage wellness and the prevention of disease through early detection, modification of risk factors, and encouragement of healthy lifestyle choices. When illness cannot be prevented, the focus should be on care coordination.

Another critical principle in health reform is the recognition that health care is a shared responsibility. Employers, individuals, and government all have a role to play -- and a contribution to make -- to the system. Employers should contribute toward health insurance choices and financing. Individuals have the responsibility to get coverage, to take better care of their own health, and to play a larger role in health care treatment decisions. Providers should improve their performance to ensure consistent, high-quality health care. Society, through state and Federal governments, should help those who lack the means to buy insurance on their own and ensure that the insurance market is fair and transparent.

With these principles in mind, it is possible to envision a high-performing health care system in the future. Such a system would guarantee Americans the choice of a health plan that they can afford. Employers, individuals, and government would all bear responsibility and contribute toward fulfilling that goal. Wellness and prevention would be encouraged. The costs of health care would be more manageable so that employers could afford to offer coverage to their employees and still compete in a global marketplace. Our public health programs would be on a more fiscally sustainable path than they are today.

Providing coverage to all Americans would make health care truly portable and allow Americans to change jobs when they wanted, rather than remaining locked in by their need for health coverage. This Call to Action represents a vision for creating that high performing health care system.

The system envisioned here guarantees access to affordable coverage for every American. To ensure that affordable options are available to all, assistance must be provided to small businesses, families, and individuals who currently struggle to find and afford health coverage. This approach will allow every American to be enrolled in some form of health care plan, either private or public. Those who like their current coverage arrangements could keep what they have. Others, including the uninsured, would have options, and all Americans would gain the ability to leave a job or start a new business without worrying about prospects for future coverage. Providing coverage to all Americans would lower costs by including the healthiest individuals in the risk pool to offset the costs of the sickest individuals -- and maintaining wellness rather than treating illness.

The system envisioned here would ensure that every individual could access affordable coverage by creating a nationwide insurance pool, precluding discrimination by insurers based on health status, and providing subsidies to low-income families. It also aims to lower costs by improving the quality of the care that all Americans receive, promoting better value for our dollar, and reforming the delivery system.

The passage and implementation of comprehensive health care reform will not happen overnight. The health system is so complex that any solution will demand time and attention to make sure that we get it right. But Americans without health insurance -- as well as those in need of better coverage or in danger of losing their coverage -- need the process to start now.

Pg 8 and 9 Final White Paper

http://finance.senate.gov/healthreform2009/finalwhitepaper.pdf

The Baucus plan incorporates six important elements as it moves towards covering all Americans:

• Individual Responsibility. Covering all Americans means the enrollment of every individual in some form of health care plan, private or public. But the principle of individual responsibility can be applied only when affordable options are available to all.

• Strengthening the Employer-Based System. We must ensure the continued viability of the employer-based system -- the principal source of health coverage for most Americans -- to allow workers to keep the insurance that they currently have and value. Eliminating employer-based coverage, as some have proposed, would upend health care for more than half the American people -- 158 million in all. This plan envisions a role for employers to contribute to employees' access to health care.

• Guaranteed Access to Affordable Coverage for Individuals and Small Business.  Additional assistance must be available to families, individuals, and small businesses who currently struggle to find and afford health insurance. A mechanism must be established to allow health care consumers to find and obtain health coverage that best meet their needs.

This mechanism -- the Health Insurance Exchange -- will connect individuals and employers to insurance offered at local, state, regional, or national levels. Insurers offering coverage through the Exchange would need to meet certain requirements established by a new Independent Health Coverage Council.

Reforms enacted through the Exchange could improve access to health coverage for all. In order to make insurance affordable, the existing insurance market must be reformed. The lack of appropriate standards and regulation in certain markets fails far too many Americans who need health care. Requirements of the Exchange would be extended to improve fair price and quality competition in the insurance market as a whole so that coverage would be more affordable and available to more Americans.

Creation of the Exchange would take time, but more immediate steps could provide relief to Americans most in need of health coverage and begin to improve the health of the country overall.

• Strengthening Public Programs. Existing public programs represent an effective and efficient way to increase access to coverage and decrease the number of uninsured. Offering individuals approaching age 65 the chance to buy into Medicare early and eliminating the requirement that disabled individuals wait two years to enroll in Medicare would ensure coverage to populations that the private market is under-serving. Improving Medicaid and the State Children's Health Insurance Program (CHIP) could provide coverage quickly to additional low income Americans while serving current beneficiaries better. Increased attention and funding for the Indian Health Service (IHS) could improve care for Native American and Alaska Native populations. We can strengthen public health care programs promptly, though the impact on state and Federal budgets must also be considered.

• Focusing on Prevention and Wellness. Increased access to preventive care and wellness is another step that could be accomplished in the short term. Increasing the availability and effectiveness of primary care coverage could create a national focus on maintaining wellness, rather than treating illness -- which would improve quality and reduce costs across the health care system.

• Addressing Health Disparities. In our current health care system, racial and ethnic minorities disproportionately lack ready access to high-quality medical care. This gives rise to differences in both health status and health care among various groups in our diverse population. Our system also prohibits certain legal immigrants from getting health care for five years. Though medical advances benefit much of the population, health disparities continue to worsen for others. These disparities must be addressed and ultimately eliminated. Americans want and deserve a system that provides equal access to health coverage and health care for all -- regardless of age, race, ethnicity, or income -- and that is what this Call to Action would give them.

These six elements combine to give every American a role and a responsibility in reforming our health care system to ensure coverage for every individual. The remainder of this chapter provides additional detail on these elements.

Pgs: 13, 14 Final White Paper

http://finance.senate.gov/healthreform2009/finalwhitepaper.pdf