Citizen-led efforts to institute more universal health care programs are cropping up across the country.
Some are very similar to the Canadian health care system.
They call for a single-payer system, meaning that medical care would be
paid for out of a single publicly administered pool of money, rather
than by myriad managed care plans. In most plans the health insurance
program would be administered by a health care "trust," governed by a
combination of stakeholders, including health care advocates,
providers, organizations and experts, taxpayer representatives, and
state officials.
Providers would still charge on a
fee-for-service basis, with fees determined through negotiations
between these stakeholders. Patients would still have the freedom to
choose their health care provider. "Medically necessary" care would be
covered. Many plans have some sort of sliding premium scale, whereby
the poorest residents of the state would pay no health care taxes, and
the wealthiest residents would pay the most.
Here we highlight some single-payer and universal health care initiatives that have been introduced or put in place.
More Information:
- The Robert Wood Johnson Foundation's provides a
wide array of information on state efforts to expand coverage. Their
shows what each state is doing with Medicaid, SCHIP, and state-only
programs. Also look for their annual State of the States report. State Coverage InitiativesState Coverage Matrix
- The Urban Institute's Assessing the New Federalism
section has reports on state fiscal policy related to health and
wellbeing, as well as state profiles of health insurance, access, and
use.
- Policymakers interested in employer mandates should read the National Academy for State Health Insurance Policy's Revisiting Pay or Play: How States Could Expand Employer-Based Coverage Within ERISA Constraints.
- A Public-Private Partnership for Health Care For All Marylanders - Maryland Citizens' Health Initiative, December 2002
This report is a blueprint that Maryland can follow to achieve a
market-based, fair, responsible, and economically sound universal
health care system.
- White Paper: "Physicians' Working Group on Single - Payer National Health Insurance - by the Universal Health Care Working Group, May 2001
- The Canadian Cure - by Daniel Kraker, The New Rules,
Winter 2001. This article explores how Canada's provinces established a
health care system founded on equity, public administration and
decentralized control.
- American Health Care Reform
- Physicians for a National Health Program
- Universal Health Care Action Network
- A primer on single payer health care and from the American Medical Student Association
- Universal Health Care Briefing to the Progressive Caucus - by The Physicians' Working Group on Single-Payer National Health Insurance, May 1, 2001
Canada's universal health care program
is much acclaimed and a product of state innovation. If Saskatchewan
had not had the authority to devise its government-funded universal
insurance scheme in the 1940s (a plan quickly copied by other
provinces), Canada would most likely not have the single-payer plan
that is so popular today.
More
In 1998, San Franciscans passed Measure J with a 65 percent majority
vote and made it city policy to provide affordable, preventive health
care to the uninsured. In 2006, the city passed the San Francisco
Universal Healthcare Initiative, with aims at giving an estimated
82,000 uninsured San Franciscans access to healthcare regardless of
income, immigration status, or medical condition. Launched in July of
2007,
Healthy San Francisco enrolled 3,100 people and has 14 city health clinics and 8 community affiliated clinics as of October of 2007.
More
The state of Vermont has one of the lowest proportions of uninsured
people in the country, and virtually all the state's children are
covered. This is due to a number of programs promoted and backed by
Howard Dean, governor of Vermont from 1991 to 2003.
Vermont’s Office of Vermont Health Access (OVHA) administers Medicaid and the state’s other Health Access/Health Insurance programs.
More
Twenty-two percent of New Mexicans had no health insurance in 2003,
compared to about 16 percent nationwide. That statistic has prompted
health care advocates to introduce universal health care legislation
every two years since the early 1990s. Current efforts focus on the
Health Security Act, which has evolved and improved due to public
feedback since it a version was first introduced in 1993.
More
In July 2004, State legislators took the first step toward a
constitutional amendment to "ensure that no Massachusetts resident
lacks comprehensive, affordable and equitably financed health
insurance..." The legislature needed to vote again during the 2005-2006
session on whether to allow the initiative to appear on the statewide
election ballot. They did indeed act and passed a bill in April 2006.
On July 12, 2006, the legislature voted 118-76 to send the amendment to
constitutional committee for study. This will delay the ability for
this to appear on the November 2006 ballot, but advocates hope that it
will be on the November 2008 ballot.
More
A bill to create the
Advisory Committee on Consolidated Health Care Financing
was passed and funded in the summer of 2000. It was part of compromise
legislation drawn up as a result of the statewide ballot initiative for
a universal program.
(For more about the ballot initiative, see
Medical Student JAMA,
October 1, 2003.) The committee's mandate was to analyze a financing
system for health care "accessible to every resident of the
commonwealth". A
final report was published in December 2002.
More
DIRIGO HEALTH is Maine's universal access to health coverage plan. The
new law is a plan to provide affordable health insurance to small
businesses and individuals and to control health care costs. The
legislation offers a phased-in approach with an ultimate goal to ensure
that all of Maine's citizens have access to health care by 2009.
More
The Connecticut Health Care Security Act is a good single-payer model for other states to follow.
The
Act would have insured payment for all medically necessary services,
medications, and long term care for all residents of the State of
Connecticut. The bill sought to put decisions about health care in the
hands of licensed health caregivers and their patients without insurer
pre-approval.
More
The California Health Insurance Reliability Act is based on a model released in January 2005 by the Lewin Group,
an independent health care analysis firm. It would provide all state
residents with full coverage of medical, dental, vision, and
hospitalization services, and pharmaceutical benefits, through a
statewide, single payer system.
The Lewin Group study
was commissioned by California Health and Human Services, in accordance
with a bill passed by the state legislature in 1999 that required a
study of universal health coverage options. Nine proposals were studied
– three single payer models and six proposals that increase coverage
through public program expansions, employer incentives, or combination
approaches.
More
Enacted in August 2005, the New York City Health Care Security Act
requires any grocery store with 35 or more employees or any retailer
larger than 10,000 square feet to contribute $2.50 to $3.00 towards
health care for each hour an employee works.
City
Councilors said the measure was necessary to prevent employees from
having to rely on public health programs paid for by the city and
state. The law will expand health care for up to 6,000 employees in the
grocery industry and protect coverage for 21,000 employees now
receiving health care through their employers.
More
Muskegon County, Michigan (population 172,000) has a comprehensive
community health model that includes a community owned health plan for
small businesses, an oral health and vision programs for children,
diabetes and chronic condition management programs, healthy lifestyle
promotion, and many other initiatives aimed at improving the overall
health of the community.
More
The Alameda Alliance for Health is a not-for-profit managed care
program in Alameda County, California. It has offers two programs:
Alliance Family Care, which provides coverage to low-income families on
a sliding scale basis, regardless of immigration status; and Alliance
Group Care, which is a subsidized health benefits package for in-home
supportive services workers.
More
Since 1971 all Canadian citizens, regardless of income, employment or
health, have enjoyed access to basic health care, whether it's provided
in a hospital, home or clinic. Canada provides this coverage at a
fraction of what the United States pays in health care costs. Americans
spend 14 percent of their GDP on health care expenditures; Canadians
only 9 percent. Yet despite its high cost, the U.S. system fails to
insure more than 44 million of its citizens. Some analysts predict that
figure will grow to 60 million by 2008.
More
Comments
thanks
thank you for the post. President Obama said in a speech six years ago that the only reason single-payer proponents should tolerate delay is "because first we have to take back the White House, we have to take back the Senate, and we have to take back the House."
Post new comment