Even if Daschle had been confirmed, his book really adds very little to the discussion. One good point in the book is about a "Federal Health Board," but the origin of the idea is not clear because it's also included in the "Guaranteed Healthcare Access Plan" in Healthcare Guaranteed.
Healthcare Guaranteed does a tremendous job of concisely explaining the whole range of issues at stake in our healthcare crisis as they affect all the parties involved. It clearly presents the pros and cons of all the various options that are part of the healthcare reform debate. For those of us who have stubbornly stuck to our belief that a national (single-payer) health system in the Canadian or British mold is the best option, or for those who believe that incremental change is the way to go, Healthcare Guaranteed presents convincing arguments for more comprehensive reform while still maintaining a market-based plan.
I highly recommend that everyone read Healthcare Guaranteed for themselves (it's only 190 pages); but for those who won't ever get to it, the below captures the conclusion of the book which compares the author's proposed Guaranteed Healthcare Access Plan to a single-payer plan, incremental reform, and mandate plans such as the Massachusetts plan. But read the book for a thorough explanation and discussion of the summary comparison and share your understanding with family and friends!
Comparative Summary of Healthcare Systems
Reform Needs - Goals of Reform and Key Questions [reflecting the seven essential elements that should be part of any reform plan]:
1. Guaranteed Coverage
Does the proposed plan guarantee healthcare coverage for all Americans--not 96% or 97% but 100% of them? Does the proposed plan guarantee a defined set of benefits that includes office and home visits, hospitalization, preventive screening tests, prescription drugs, some dental care, mental-health care, and physical and occupational therapies with no deductibles and minimal co-payments?
Guaranteed Healthcare Access Plan - YES
Under this plan, all Americans would receive coverage through a health certificate/voucher that provides the same benefits that members of Congress currently receive.
Incremental Reform - NO
Incremental reform would permit some expansion of coverage, primarily through expansion of SCHIP or Medicaid, but most uninsured Americans would remain uninsured.
Mandates - NO
Mandates would permit coverage of 97% of Americans; however, some would not buy coverage, and others would still find it unaffordable and be exempted.
Single-Payer - YES
All Americans would receive coverage through Medicare or a single National Health Plan.
2. Effective Cost Controls
Does the proposed plan improve efficiency by reducing administrative costs and reducing fraud? Does the proposed plan eliminate multiple financing mechanisms and redundant bureaucracies? Will the proposed plan rein in rising healthcare inflation resulting from diffusion of technology and cost-ineffective care?
Guaranteed Healthcare Access - YES
This plan would improve efficiency by reducing insurance administrative costs from underwriting, sales, and marketing; eliminating state spending on income eligibility; and eliminates employers' administrative oversight costs for overseeing of health insurance. Through the dedicated VAT, benefits would be tied to revenue. (Increases in benefits would require increases in taxes.) The Institute of Technology and Outcomes Assessment would permit evaluation of new technologies for use.
Incremental Reform - NO
Incremental reform would rely on the current system without any reductions in administrative costs and without implementing cost-control mechanisms.
Mandates - NO
Mandates would rely on the current system with a few reductions in administrative costs through the Insurance Exchange. Some administrative costs will increase due to processing for income-linked subsidies. There is no implementation of long-term cost-control mechanisms.
Single-Payer - YES and NO
Single-payer systems would improve efficiencies by reducing insurance administrative costs from underwriting, sales and marketing; eliminating state spending on income eligibility; and eliminating employers' administrative costs for overseeing of health insurance. Single-payer systems would have no implementation of long-term cost-control mechanisms, other than tactics shown to fail elsewhere, such as restrictions on fees and payments to providers and negotiated drug prices.
3. High-Quality Coordinated Care
Does the proposed plan have a mechanism to reduce the number of medical errors, hospital-acquired infections, high-cost/low-to-no-benefit treatments? Does the proposed plan encourage coordinated care and innovation in delivery, while holding providers accountable for high-quality outcomes? Is there a process for regularly evaluating the quality of the providers?
Guaranteed Healthcare Access - YES
Such a mechanism would promote excellent care through fixed payments to care for patients, requirements to report patient outcomes and quality of care, strong financial and other incentives to develop infrastructure, information systems, and provider incentives for coordinated care. The Center for Patient Safety and Dispute Resolution would facilitate implementation of patient safety measures.
Incremental Reform - SOMEWHAT
Although incremental reform would encourage the use of electronic medical records, it would also rely on the existing fragmented, fee-for-service delivery system without any linkage to payment or other mechanisms to ensure high quality coordinated care.
Mandates - NO
Mandates would rely on the existing fragmented, fee-for-service delivery system.
Single-payer - NO
Single-payer systems would rely on the existing fragmented, fee-for-service delivery system.
4. Choice
Would Americans be able to choose their health insurance plans, physicians, and hospitals? Does the proposed plan give citizens the freedom the purchase extra healthcare benefits beyond the standard benefits guaranteed to all?
Guaranteed Healthcare Access - YES
American could choose their doctors, hospitals and insurance company. They could also choose whether to buy additional services not included among the standard benefits.
Incremental Reform - NO
Incremental reform would rely on the current system in which most Americans have limited or no choice of doctor, hospital or insurance company.
Mandates - YES and NO
Some people--the self-insured, uninsured, and other in the Insurance Exchange--would have wider choices among insurance companies. But most people would remain in the current system where their choices are limited.
Single-Payer - YES
Americans would be able to choose their doctors and hospitals but not their medications, which would be paid for through the national formulary.
5. Fair Funding
Does the proposed plan have a way of financing in which all Americans contribute fairly?
Guaranteed Healthcare Access - YES
This plan would rely on the VAT, to which all Americans would contribute based on what they spend. The average family would receive a health insurance plan worth over $11,000 while paying about $4,500.
Incremental Reform - NO
Incremental reform would rely on the current system which, with its tax subsidies and employer-provided coverage and Medicare payroll tax, is highly regressive. Added money would come from a regressive payroll tax.
Single-Payer - UNCLEAR
Most single-payer systems do not specify what taxes would fund the plan.
6. Reasonable Dispute Resolution
Does the proposed plan offer a mechanism for reasonable resolution of claims to compensate injured patients quickly and fairly while protecting physicians from frivolous lawsuits and skyrocketing malpractice premiums?
Guaranteed Healthcare Access - YES
The Center for Patient Safety and Dispute Resolution would receive and adjudicate all complaints. Patients who are injured would be quickly and fairly compensated. Malpractice insurance would be substantially reduced and used only for those cases not resolved by the Center.
Incremental Reform - NO
No proposed change.
Mandates - NO
No proposed change.
Single-Payer - NO
No proposed change.
7. Economic Revitalization
Does the proposed plan eliminate healthcare considerations from the purview of business, so business can focus on its core competencies? Does the proposed plan guarantee total portability? Will the proposed plan reduce labor-management conflict and permit hiring decisions based on productivity not fringe benefits?
Guaranteed Healthcare Access - YES
This plan would remove responsibility for healthcare from employers, guaranteeing portability and eliminating job-lock and other sources of labor-management conflict. Cost-control (see #2) would free up resources for other economic benefits.
Incremental Reform - NO
No fundamental changes in this area would occur under incremental reform.
Mandates - NO
Mandates would leave responsibility for healthcare largely in the hands of employers. And without long-term cost control, they would result in a serious drain on the government's ability to fund the economy and other programs [like education].
Single-Payer - YES and NO
Single-payer systems would remove the responsibility for healthcare from employers, thereby guaranteeing portability; however, without long-term cost control, they would result in a serious drain on the government's ability to fund the economy and other programs.
I am a civil servant, so I have good health insurance; but I have family members who are among the millions without access to affordable health insurance, and I believe we need comprehensive reform NOW, not 2 or 4 years from now. I plan to do what I can to get information about the Guaranteed Healthcare Access proposal and the comparison to the other options out to everyone I know, and do what I can to develop community support for the best plan, which I believe is the Guaranteed Healthcare Access proposal.