[July 15, 2006, AJHP News]

BETHESDA, MD, 29 June 2006 — A congressionally mandated panel whose mission is to discover what ordinary people want from the health care system has called for the creation of a basic package of benefits for all Americans by 2012.

"Americans should have a health care system where everyone participates, regardless of their financial resources or health status," states the interim recommendations from the Citizens' Health Care Working Group. These health benefits should be "sufficiently comprehensive to provide access to appropriate, high-quality care without endangering individual or family financial security," according to the panel's findings.

The recommendations, released June 1, are intended to represent the voice of the American people as presented to the 14-member citizens' panel online, in writing, and during public meetings held across the nation this past winter and spring.

In all, the panel made six main recommendations:

1. A public policy, established in law, should guarantee affordable health care for all Americans.
2. A national core package of physical, mental, and dental health benefits should be defined using evidence-based principles.
3. Everyone should be shielded from very high health care costs.
4. The federal government should support integrated community health networks and coordinate the support of the health care safety net.
5. The federal government should promote evidence-based improvements in health care quality and efficiency.
6. The financing and provision of end-of-life care should be restructured to improve access to palliative services for those with incurable conditions.

"These recommendations outline a vision and a plan for achieving broad-based change in health care in America," the interim document states. "We recognize that the issues involved are complex and challenging, and that it will take time and a great deal of technical expertise, as well as political will, to make the changes we think are necessary."

The committee's full recommendations are available at www.citizenshealthcare.gov. The panel is accepting public comments on the recommendations through August 31. All public comments on the interim recommendations are to be posted online.

In general, the public's comments on the interim recommendations so far represent a wide range of views on what kind of health care system currently exists in the United States, how or if the health care system needs to be fixed, and who should pay for changes to the system.

After the comment period ends, the panel will produce final recommendations for the President, who is required by law to review and comment on the recommendations in a report for Congress. The President is also obligated to suggest legislation and administrative actions related to the panel's findings, if appropriate. Within 45 days of receiving the President's recommendations, two Senate and three House committees must begin hearings evaluating those recommendations and the panel's work.

Health care policy expert Shoshanna Sofaer of Baruch College in New York City said that although she was disappointed that the report lacked direct quotes from the public, she was pleased by most of the recommendations in the document.

"They're good recommendations," Sofaer said. She added that she was particularly pleased that the group tackled end-of-life care, a topic that is usually covered by "policy wonks," not the broader public.

Sofaer was a member of the Institute of Medicine (IOM) Committee on the Consequences of Uninsurance, which issued a series of reports from 2001 to 2004. The committee's final report had recommended that universal health care coverage be available to Americans by 2010.

But Sofaer doubted that her group's recommendations or those of the citizens' panel will be adopted by their target dates.

"The political planets have to be in alignment [for universal coverage], and they aren't now," Sofaer said. "And they won't be until we get leadership on both the executive branch and the legislative branch at the national level."

The citizens' committee did not provide a detailed plan for financing universal coverage but proposed a combination of enrollee contributions and income taxes, value-added taxes, and so-called sin taxes. The group explained that "large majorities" of the American public have said they are willing to pay more to support the expansion of access to high-quality health care.

The interim report also stated that health care spending "needs to be considered in the context of other societal needs and responsibilities."

About 18% of Americans under age 65 yearsmore than 45 million peoplelacked health insurance in 2004, according to the most recent data from the nonprofit Kaiser Family Foundation. The remainder of the so-called nonelderly population relies on employer-sponsored insurance plans, private plans, or public programs like Medicaid and Medicare for coverage of medical costs.

Publicly financed insurance coverage through the Medicare program is available to people age 65 years or older and to certain disabled Americans. Medicaid coverage is available mostly for low-income households with children. Nearly three-fourths of adults in childless households with earnings below the federal poverty level receive no assistance from Medicaid, and nearly half lack insurance coverage from another source, according to Kaiser.

Some of the comments on the interim report that have been posted to the panel's Web site expressed a belief that Medicaid and Medicare coverage is universally available to meet the health care needs of the poor. Other commenters have stated that Americans already have access to universal care because hospitals cannot turn people away when they seek emergency services.

Language creating the citizens' panel was included in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 at the behest of Senators Ron Wyden of Oregon and Orrin Hatch of Utah. Panel members were chosen in February 2005 by U.S. Comptroller General David Walker from a pool of more than 530 applicants. Panel members have different backgrounds, and health care lobbyists or politicians were ineligible for the committee.

Health and Human Services Secretary Michael Leavitt is part of the committee by statute and will be formally presented with the group's final recommendations. Leavitt did not participate in formulating the interim recommendations, according to the June report.

—Kate Traynor

You are not alone. We are working in concert with many organizations whose work and resources address the need for a continuum of health care services in our underserved communities. Together we will overcome the barriers that our patients and clinicians face to secure high quality, patient centered, culturally appropriate health care for our patients, our families, our friends, and ourselves.