TO: Senator John Smith (D-NY)
FROM: Senior Advisor
DATE: 20, March 2007
RE: Health Plan Recommendations for Presidential Platform

Introduction
The increasing number of uninsured and underinsured individuals in the country is an epidemic that will only worsen over time for a variety of reasons that I will outline in paragraphs below. Since the various proposals introduced recently by the President are not helping the majority of the population, I suggest that your platform incorporate some of the proposals presented by several congressman, health care working groups and coalitions, and initiatives already undertaken by numerous governors to combat the escalating health costs to their states in order to address and remedy the nationwide discontent with the health care system. Below are my suggestions for the basic tenets of a successful platform on health care:

• Primary and Preventative Care:  Encouraging primary, preventative care is far less expensive and more effective in preserving health as opposed to our current system that treats patients after they become ill and incur high medical costs.

• Public/Private Partnerships:  Supporting efforts to ensure access to affordable healthcare for all through public/private partnerships between the government, businesses, and insurance companies that will satisfy both parties’ ideologies.

• Encourage State Experimentation:  Several states such as Massachusetts and California have made monumental efforts to insure all their residents. Therefore your platform should encourage individual states to experiment with health care proposals in order to achieve the most effective method to achieve affordable and comprehensive health coverage for everyone in their state.

• Lend Federal Support to State Plans:  The Federal government should assist states by providing them with a broad framework within which they can operate, conduct research, reform unfair tax practices that discriminate against certain types of insurance, and provide them with funding to help them initiate their plans.

• Health IT:  Support the development of a uniform, national health IT system, such as VISTA used by Veterans Affairs, to improve the management of patient health records and cut down on inefficient medical costs.

Current Health Care Situation
The U.S. spends the highest amount per person in the world on health care - 15% of our GDP.  This amount is projected to double by 2016 to $4.1 trillion annually. Census figures also illustrate that 1 in 6 Americans currently lack health insurance and those with coverage are increasingly becoming underinsured. Even though the majority of Americans under the age of 65 still receive some health insurance from their employers, premiums have steadily increased in the face of escalating health care costs, technological advancements, and economic downturns. There is a growing public consensus to remedy the inefficient health care system as these costs rise much faster than wages and inflation, crippling American businesses and families in the process and eroding the middle class. As employer-sponsored coverage declines, more people will be employed in jobs without coverage and many will rely on providing coverage for their families through public programs such as Medicaid and the State Children’s Health Insurance Program (SCHIP), further increasing government spending that is already burdened by programs like Medicare.

• Medicaid:  This federal/state program is available only to certain low-income individuals and families who fit into the eligibility group.

• SCHIP: A joint Federal/State venture that covers low income children, and is administered by the states to determine their program’s design.

• Medicare: This federally funded program covers almost the entire population over 65 and those with certain disabilities and diseases, regardless of income requirements.

Even though enrollment for Medicaid and SCHIP have recently increased due to the increasing number of uninsured and improved outreach, SCHIP is a capped program whose expenditures are projected to increase dramatically in the future, and Medicaid’s income requirements are too low for even many low-income adults to qualify for the program.

As the uninsured delay treatment for fear of incurring expensive health care bills, they visit Emergency Rooms as their only source of health care, costing the nation billions in lost productivity and enduring high rates of medical bankruptcy themselves. Their uncompensated hospital costs are offset by increased premiums to the insured, and at massive costs to the government, hospitals, and tax payers. Additionally, as countless Americans stay trapped in “job lock” due to fear of losing their health insurance, our nation loses an immeasurable amount of entrepreneurial revenue. The strain on big business is also evident as American companies like General Motors struggle to stay afloat in the global market. Japanese automobile makers, who are not the sole sponsors of health insurance for their employees, are surpassing American makers who are exclusively burdened by their employees’ health insurance costs that severely cut into their profit margin.

Recently however, coalitions of unlikely partners such as AARP, Business Roundtable and SEIU have emerged to champion affordable health coverage for all in the ‘Divided We Fail’ campaign that aims to infuse the subject of health and long term financial security into political dialogue. The ‘Health Coverage Coalition for the Uninsured’ is another group of influential, and often ideologically conflicting, national health care organization that represent businesses, pharmaceuticals, hospitals, physicians, consumers and insurers. All these entities have set aside their differences and collaborated to advocate for access to affordable health care for the millions of uninsured Americans; a movement that aptly reflects the American public’s desire for a bipartisan approach to achieving sustainable health care reform.

Presidential Solution
A recent New York Times/CBS poll confirmed that a majority of Americans claim that the federal government should guarantee health insurance to every American - especially children. To achieve this goal, people are agreeing across party lines to pay higher taxes since the costs would be shared by everybody. The public has placed access to affordable health care at the forefront of the agenda for the 2008 Presidential election as more important an issue than immigration, preserving traditional values and lowering taxes.

Despite this majority consensus for a government initiated universal health care, we must be cautious not to repeat past mistakes. The philosophical rifts along party lines that divide Americans over whether the government should implement a national health care plan, and whether the government can do a better job than the private sector in providing coverage, still exist. One President or one bill cannot attempt to overhaul the leviathan that is our health care industry; as was one of the problems with the Clinton Administration’s plan for universal health care. The plan collapsed under attack from the insurance industry, businesses and pharmaceutical companies; all fearing that universal health care amounted to a gargantuan government take-over. Successful and sustainable health care reform must evolve gradually, stemming from bipartisan support including that of employers, government, labor and the states.

Since all these entities are now advocating for health care for all, the time is ripe for you to initiate an innovative plan of action.

• You must communicate your idea to the public as an ideal compromise between the conflicting, deep-rooted American ideals about government regulation.

• Publicly, you should commit your presidency to achieving affordable health care for all in a broad public/private partnership framework in which the government subsidizes private insurers to provide coverage.

• The states are free to experiment and fashion their own individual approaches to insuring their residents in the most efficient way possible for them.

• Congress must create a bipartisan entity to review state proposals to achieve affordable coverage for all persons, and supply the states with federal funding to implement their initiatives.

Under these flexible federal regulations, the employer-based system will be alleviated from the burden of serving as the sole sponsor of health insurance; but would act as a risk pool to obtain tax subsidies for employees to receive affordable health coverage through private insurance.

You must also ensure the millions of Americans insured through Medicare and Medicaid that the programs will not only remain in place, but will be improved as you implement a national health IT system to reduce wasteful administrative expenditures. You must also increase funding for SCHIP to cover all the 9 million uninsured children. SCHIP has overwhelming bipartisan support because covering children is politically favorable for both parties and because children’s health services are drastically cheaper than adults’ health care while ensuring long lasting health.
 
Your plan will be accepted by the public since it is meshes both parties’ dogma to arrive at an efficient and truly American solution that upholds the ideals of federalism yet recognizes the public consensus to extend coverage to everyone to remedy our health system. Although some Democrats may contest your proposal since it does not mandate a national plan, they will be tempered by achieving their goal of insuring everyone. Republicans will also be satisfied since states retain control, and the private sector will remain operational to provide Americans with choices. In essence, a private/public partnership is the only way to truly begin reforming our health care system, and the ideal method that will ensure your success in your campaign for the Presidency.