A reformed health system will likely include both public and private coverage choices. Public programs are not perfect, but current health reform proposals provide an opportunity to expand on their strengths and improve weaknesses.
Public programs—notably Medicare, Medicaid, and the State Children’s Health Insurance Program—have evolved to insure people with the greatest health needs or the least resources. These programs cover one out of every four Americans, including the elderly and the disabled under Medicare; low-income families, the elderly, and the disabled under Medicaid; and low-income children and parents under SCHIP.
These programs have often led the way in systemic change. Medicare’s policies toward hospital desegregation and access to appropriate language translation and interpretation services have transformed access to care for many racial and ethnic minorities. The Veterans Administration was among the first to use personal medical records and health information technology. Medicare is again taking the lead in improving quality by ending payments for "never” events, which are serious yet preventable incidences that can be costly, such as operating on the wrong body part.
Public programs will play a critical role in health reform, and reform is an important opportunity to improve the health safety net. Reform should expand eligibility for public programs and ensure that people can easily enroll in and keep public coverage. To ensure success, provider rates should not only be increased, but also reformed to give providers incentives to coordinate care, including through medical homes for patients, where their primary care physician takes the lead in managing and coordinated care. Public programs should be leaders in designing and implementing disease management initiatives that will help the millions of Americans with chronic conditions get and stay healthier. These improvements can drive health system changes that will be critical to the success of comprehensive health reform.
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