Health reform will be most successful when we try to achieve coverage for all and cost containment at the same time. In fact, the two are on different sides of the same Rubik’s cube.
There is a false dichotomy held by some that there is an either/or choice in health reform—that either we achieve coverage for all first or that we will attempt to contain the skyrocketing costs first. The extremist version of this view holds that cost containment should be the only goal because the system is so broken and expensive that the government can’t take steps to cover more people. But this approach misses the point entirely. The question is not whether we can afford to ensure that all Americans have health coverage. The question is whether or not we can afford to leave people behind.
Health insurance works best when it is continuous. Disease management and prevention are not short-term or intermittent activities. Even short periods of uninsurance can lead to diminished health status as individuals lose access to the care they need. In addition, continuous health coverage is the key to coordinated care. Care delivery in our health care system is already highly fragmented, with many patients receiving care from multiple providers, particularly high users of care such as the elderly and those with chronic conditions. This is a top-cost driver that we can only address by continuous, coordinated care. Study after study has found that we can contain health care costs through better management of chronic disease.
Coverage for all will also help contain costs by reducing cost shifting and thus bringing some measure of sanity to how we finance our health care system. As a Brookings Institution economist has noted, broadly expanding coverage is “a precondition for effective measures to limit overall health care spending.”
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