The Pathway to Universal Care Through Radical Incrementalism

The O'Connor Health Care Magna Carta provides the philosophical underpinnings for our Pathway to Universal Health Coverage.

The explicit recognition that our current systems of health care coverage and delivery leaves over 40 million Americans uninsured motivated our design. Changing the system with many entrenched stakeholders will be challenging, which is one reason why we chose to build our Pathway Plan from a successful existing structure: the Medicaid program. To avoid political battles over benefits and administration we chose not to rebuild the wheel. Instead, we fitted the Medicaid/SCHIP programs with a slick new tire.

Our plan emphasizes risk pooling and purchasing leverage by reshaping our current system into several large purchasing pools, both at the federal and state level. Private insurance including state and local government plans, MedicaidISCHIP, Military Health as well as Veterans and Tribal health will be merged into combined risk pools. While building from a solid foundation, our Pathway Plan will fundamentally reshape health care coverage, significantly lower costs, and reshape the delivery of coverage in this country in a way that will ensure that all Americans have access to both coverage and medical services by the end of seven years from initial implementation.

Our plan contains many innovative features that will strengthen the existing framework of Medicaid. A key feature is the development of local HealthWatch coalitions that link the local, state and national voices of key stakeholders. HealthWatch coalitions will combine a monitoring and advocacy role in a newly created Office of Health Care Advocacy and Outreach. Under these auspices, key stakeholders will have an opportunity to comment on emerging issues. They will also be able to review and recommend changes to the contracts that are developed between purchasers and payers of health care coverage. A state-of-the-art advocacy system will include health benefits counseling to assist people negotiating the health care coverage systems. Health care "navigators" will serve individuals who may need extra assistance due to language, culture, or physical needs, enabling them to negotiate systems of care and coverage appropriately and with confidence. The office will also provide advocacy assistance and easy access to print and web-based information about health care and health plans.

Our Pathway Plan will provide for a universal set of health care services that protect our children and provide essential coverage to adults, including those with special health care needs. The Pathway Plan will offer states flexibility guided by minimum federal standards for matching funds. Low-income individuals will have their health care services subsidized, but with costsharing on a sliding fee scale, up to 300% of the federal poverty level.

Employers will have an opportunity to provide coverage for their employees at a significantly lower cost. As an added incentive, employers will be able to claim a tax credit of sixty percent of employer-paid premium costs. Our Pathway Plan will provide state-of-the-art medical services through the Medicaid program, which has been described as "the best health insurance in the world." More importantly, additional costs saved by efficiencies in the new system will be directed to provision of care rather than pushing of paper.

Finally, our Pathway Plan, by involving all of the key stakeholders, will generate a critical mass of support within seven years to obtain near universality of coverage. Everyone will have an opportunity to help shape the proposal, but everyone will have a responsibility to contribute both resources and time to ensure that our system is responsive to the needs of all Americans.

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