These changes will require a lot of work, but transformation is indeed possible. A recent Commonwealth Fund survey of health care leaders found a notable convergence of opinion among the nation's foremost experts, even on as difficult a challenge as reducing the percentage of Americans without health insurance. These experts agreed it is possible to cut the uninsured rate in half over the next ten years and to hold health care spending to a modest increase, from 15 percent to 16 percent of gross domestic product.
(39)Leaders across the health care sector—from academia and research institutions, health care delivery organizations, health insurance companies, pharmaceutical and other health industries, consumer advocacy organizations, labor, and government—showed remarkable consensus on a policy agenda and options for change. Their top five priorities for Congress include expanding coverage to the uninsured; improving the quality of medical care, including increased use of information technology; instituting reforms to ensure the long-run solvency of Medicare; establishing measures to moderate rising health care costs; and adjusting Medicare payment reforms to reward provider performance on quality and efficiency.
(40)The survey respondents were also surprisingly
unified in their opinions regarding the most promising policy strategies.
To expand health insurance coverage, they recommend letting small
businesses and individuals buy coverage through the Federal Employees
Health Benefit Program, giving incentives to employers to expand
coverage, providing tax credits or other subsidies to low-wage workers,
requiring employers to contribute to a fund if they don't provide
coverage, and providing federal matching funds for expansion of
Medicaid and the Children's Health Insurance Program to everyone
below 150 percent of the federal poverty level.
(41)To tackle the issues of quality and health care costs, they recommend rewarding more efficient and high-quality medical care providers, improving disease management and primary care case management, using evidence-based guidelines to determine when a test or procedure should be done, expanding the use of information technology, and having all payers (including private insurers, Medicare, and Medicaid) adopt common payment methods and rates.
(42)These are just a few of the possibilities before us. The Commonwealth Fund Commission on a High Performance Health System will examine these and other options available to a nation with such exceptional resources and capacity. It is our hope that the Commission's work will be pivotal in moving the nation toward a high performance health system, one that offers better access, improved quality, and greater efficiency to all Americans.
