Treating America Right: Better
Care Thatfs Always There
Joe
Liebermanfs Workable Solution To Americafs Health Care
Crisis
For far too long, America's health care system
has seemed plagued by a series of intractable problems with no effective solutions. The problems are obvious: Our nation has the most expensive health care system in the world, yet we have far from the best health. We have the best health care providers, yet millions of Americans are dissatisfied with how the system treats them. We have the most innovative and creative medical research, yet we fail to prevent or cure many chronic diseases.
Yet our political system appears incapable of making progress in solving them. Some Democrats continue to offer big government remedies that have been rejected before. But we have learned the American system cannot be changed all at once. George W. Bush has taken the complete opposite approach, doing little or nothing to expand coverage for the uninsured, bring down the spiraling cost of insurance, or improve the currently uneven quality of care. The result: 41 million Americans, including 9 million children, lack health insurance; those ranks are growing by a million each year; and anxiety among all Americans has never been higher.
Today, Joe Lieberman presents a workable health care plan that will break the deadlock -- and make our health care system work better for the American people. The Lieberman plan calls for a practical, step-by-step approach to universal health care that recognizes the fiscal constraints of the Bush economic failures -- and charts a clear, realistic course to health care for all. It also calls for a range of innovative new initiatives to expand access to care, lower costs, and improve the delivery of services for everyone. Joe Lieberman understands that the American people donft just want more coverage, they want better care.
The Lieberman coverage plan -- which builds on recommendations from health care leaders, including providers and patients -- mixes basic common sense with bold new ideas to give the American people the care they deserve at a price they can afford. It smartly targets our resources first to the people who need it most -- kids, single moms, the unemployed, and workers currently shut out of the system. And it harnesses the best forces of the market and the positive power of people making choices for themselves to build on what works -- and fix what does not.
By combining these approaches, the Lieberman plan will cover more uninsured Americans -- more than 31 million -- than any other competing, non-single payer proposal. Better yet, it is the most cost-efficient: according to an independent economic analysis, the Lieberman plan will cost an average of $53.4 billion over the first five years, and will cost less per newly-insured person than any other Democratic plan over 10 years. And, as an additional benefit, the Lieberman plan will save the states an estimated $400 billion in health care costs over 10 years, which will be a huge relief to state and local governments burdened with the worst fiscal crisis in the past half century, not to mention the Bush Administrationfs many unfunded mandates.
But today Joe Lieberman offers more than cold numbers and cost savings. He is setting ambitious new goals for making the system work better for people -- and a new pathway to a healthier America. The plan starts with four core principles, which are aimed at expanding coverage, reducing costs, improving quality, and finding new cures.
1. The only way to afford universal health insurance is to make health care universally affordable. In addition to the overall health care savings predicted from universal coverage (less uncompensated care, better prevention, fewer emergency room visits), the Lieberman plan will also improve overall efficiency of the health care system. Care quality improvements, reductions in medical errors, broader use of electronic medical records, and decreased disparities in care will all help save health care dollars. And the combination of better prevention, cures, and optimized chronic disease management will sharply reduce the $750 billion per year burden posed by chronic illness.
2. All children need the foundations for a healthy life. Uninsured children are six times more likely to go without medical, dental, or other needed health care. For parents without insurance, deciding whether or not to bring a child in for treatment for an earache or sore throat is a difficult one. The result is reliance on the emergency room for care, an expensive and traumatic alternative that does little to prevent illness. And illness can stand in the way of learning even if you are insured. If America is serious about leaving no child behind, all children must have health insurance, convenient and accessible health care, and health education. The Lieberman plan includes a new universal health insurance program for kids, called MediKids, and a true national network of school based health centers. These programs will ensure children have access to the health care they need, no matter what their family circumstances, and start life on the road to wellness.
3. Keeping a full-time job should not be a requirement for keeping your health insurance. For the last 50 years, most Americans have depended upon their employers to provide health insurance. While this has provided obvious and important health benefits for full-time employees of large companies, it is failing to meet the needs of more and more Americans as our economy changes -- especially in these rough economic times. Indeed, a growing number of middle class Americans discovering that health care -- long taken for granted -- now presents a serious economic challenge. Indeed, workers making between $50,000 to $75,000 per year are losing their health insurance faster than any other group in the nation. Contract, seasonal, small company, part-time, unemployed, and self-employed workers have been especially hard hit. And workers who lose their job too often find that they have, at the same time, lost access to affordable health insurance as well. That is why, in addition to providing assistance to low and moderate income workers, the Lieberman MediChoice plan will give workers of all income levels access to affordable, dependable, and meaningful health insurance.
4. Universal coverage should not be uniform -- it must come with real choice and flexible care. Families need freedom to choose the kind of health care that meets their individual needs and matches their economic priorities. The Lieberman plan provides universal access to affordable health insurance over time, but it also increases insurance options for the consumer. In addition, it will make health care more convenient and responsive to their needs. The Lieberman plan will help Americans navigate the health care maze by helping them manage complicated illnesses, compare health insurance options, and obtain access to their medical information. And it will make better use of information technology, such as electronic medical records, and thereby ease the growing burden of the sandwich generation -- those adults who find themselves simultaneously responsible for the health needs of their growing children and aging parents.
I. Coverage and Access
Health Care for All Our Children
Caring for our children is a moral imperative—and an intelligent investment. When 9 million children go without health insurance, we are clearly not meeting our responsibilities. While our poorest children need our help the most, Joe Liebermanfs health care plan will also help millions of middle class families struggling to raise healthy and happy kids. It will reduce the rolls of the long-term uninsured by almost 16 million by covering more children, pregnant mothers, and young adults. In addition, it is designed to ease the burden of busy, hard-working parents of every income level in getting quality care for their children, improve the health of our children, and make sure every child develops both mentally and physically.
Step 1: Expanding S-CHIP to Cover More Children and Their Families
In addition to the 9 million uninsured children, 33 million children and young adults have gone at least 6 months without insurance over the last two years. Joe Lieberman believes that the best way to immediately reduce this number is to expand the eligibility of the State Childrenfs Health Insurance Program. He will build upon proposals he made with Al Gore in 2000 to allow more children of the working poor qualify for S-CHIP coverage as soon as possible. He will also make sure low-income pregnant women, young adults up to age 25, and legal immigrant pregnant women and children are covered under the program.
To help states expand coverage to children of families making up to $55,000 for a family of four (or 300% of the federal poverty level), Joe Lieberman will provide new funding and incentives for states. The Lieberman plan will fully cover the expansion costs for states, allow states to invest their early S-CHIP savings back into their current programs, and give all states that cover 90% of their eligible children a 5% federal funding bonus.
Step 2: Creating MediKids, a New Universal Health Insurance Program for Children
Although expanding funding and eligibility of the S-CHIP program is a good bridge towards universal health insurance for children, it will not get us to the final goal. By design, the S-CHIP program is vulnerable to shortfalls in state budgets and requires complicated and sometimes intimidating enrollment procedures. This is particularly true for urban and immigrant communities. These hurdles are part of the reason so many children go without health insurance. Many are not aware that 6 million of the currently 9 million children uninsured are already eligible for Medicaid or S-CHIP but are still not enrolled. In addition, many uninsured children live in families that will not qualify even for expanded S-CHIP programs. To address these concerns, the American Academy of Pediatrics, an organization of more than 40,000 practicing pediatricians, has called for a new, long-term solution that can give all families, regardless of income, new affordable insurance options for their children.
Building on that recommendation, Joe Lieberman will create MediKids -- a new, flexible, high-quality health plan in which every baby will automatically be enrolled at birth or during any lapse in coverage. The plan—which parents are free to decline—would offer affordable and reliable care to ALL children through young adulthood, up to age 25. MediKids will be phased in over 5 years, and children with existing coverage, including Medicaid and S-CHIP, would be welcome but not required to change. It will start with the youngest children and, beginning on day one, every baby will leave the hospital with a birth certificate, a car seat, and health insurance.
The coverage will be comprehensive and affordable. MediKids would provided through the same approach that now covers members of Congress -- a network of federally-coordinated private insurance plans will provide choice and flexibility, and all plans will be required to offer a standard package of benefits so children would receive comprehensive coverage for preventive care, hospitalizations, prescription drugs, long-term care, all recommended vaccines, and other health care services.
To qualify, private insurers would have to agree to limit their profits to a small percentage of their costs, while federal reinsurance will protect against catastrophic losses. Coverage will also provide a limit on out-of-pocket costs, to make sure that families are not crippled by health care costs for seriously ill children.
Families earning up to 200% of the federal poverty level ($37,000 for a family of four) will receive MediKids coverage at no cost. Others will pay premiums on a sliding scale based on income, with no family paying more than 7.5% of their income for the plan. Parents will receive premium assistance through advanceable refundable tax credits. This approach would provide true fiscal relief—to families, to employers, to the childrenfs health care system, and to over-burdened states:
Families:
MediKids will be able to provide more affordable coverage to all families by pooling the risk of millions of kids, so all parents -- whether or not they receive premium assistance, will see savings.Employers:
When parents choose MediKids, employers will be relieved of some of their health insurance costs for dependents and have more financial resources to increase wages and extend the number of insured employees. They will be able to provide better adult benefits and salaries.States:
Although expanding Medicaid and S-CHIP has produced modest increases in health insurance coverage for children, it has done so at a high cost to the states. States are sometimes forced to choose between educating children and healing them. MediKids would provide fiscal relief to states and allow them to expand coverage for low and middle income uninsured adults.
Step 3: Building A National Network of School-Based Health Centers
Insurance is not the only health barrier our children confront. All children – rich or poor, insured or uninsured -- are facing increasing obesity, asthma, and diabetes rates. In schools across the country, we have cut physical education classes and added soft-drink machines. Our children donft just need health coverage, they need health care. The Lieberman Healthy Start initiative will offer both.
Joe Lieberman will provide accessible health care to children in elementary grades by building a new network of school-based health centers. Currently, there are more than 1,500 school-based health centers, which serve 2 million students in 45 states. However, despite the popularity of these centers and the growing need for these services -- particularly in rural and urban communities -- the Federal Government barely provides enough funding for two school centers in every state, let alone the 66,000 public elementary and rural schools nationwide.
Joe Lieberman will help create partnerships between states, local school districts, parents and clinicians to support and expand access to these convenient centers. As they typically are today, the school-based centers will be designed locally to reflect the needs and values of local communities, ease the burden on busy parents and meet the growing health needs of their children.
With these centers in place, children with chronic illnesses like asthma will have the help they need to stay in school. Children will be screened for serious illnesses that would otherwise go undetected, like diabetes, and referred on for proper care. And the centers will give schools more guidance in health promotion, nutrition, and physical activity to teach all children how to start healthy and stay healthy. School-based health centers will serve as the foundation for health and nutrition education for our children.
Better and Broader Care for
American Workers and Families
To offer quality and affordable care to all Americans, Joe Lieberman will create MediChoice -- a new plan designed to offer the best care to the most Americans for the lowest possible cost. Currently, the uninsured fall into several categories. People are uninsured because they canft afford it, their employers donft offer it, or they donft work for conventional employers in conventional full-time jobs.
Using the same techniques that currently provide coverage for federal employees, MediChoice pools will provide one-stop shopping for insurance. Participating private insurance plans will be required to provide cost and benefit data so consumers can make easy comparisons and choose the plan thatfs right for them. In addition, all insurers participating in the new MediKids program will be required to offer MediChoice to give families the option of combining their coverage under one policy. MediChoice, which reflects concepts originally proposed by the American College of Physicians, captures the leading thought in health care and provides a comprehensive approach to universal access to affordable insurance.
Step 1: Strengthening the Medicaid Safety Net
The MediChoice program would start by giving states the authority and additional funding to fully cover expanding the Medicaid program to all adults with household incomes less than 150% of federal poverty, or about $28,000 for a family of four. For the first time states would be able to use federal funding to provide coverage to poor, uninsured adults who are neither caring for a dependant child, elderly, nor disabled. This approach will also simplify Medicaid eligibility and streamline enrollment.
Step 2: Giving New Options to Workers
Today in America, the middle class is losing insurance faster than any other group. Joe Lieberman will enable all Americans who donft have access to affordable, conventional group health insurance to buy into new MediChoice health insurance pools -- modeled on the health care program for federal employees. MediChoice pools will be state-based to provide the most flexibility, but states will have the option of enrolling in a federal pool as well. By combining the purchasing power of the uninsured and limiting insurance company profits, MediChoice will offer affordable premiums and comprehensive care.
The MediChoice pools will be open to all workers who currently fall through the health insurance cracks. This includes self-employed, part time, seasonal, and temporary workers who do not typically enjoy generous health benefits. It will also give stay-at-home moms, early retirees over 55 years of age, and workers in small companies with less than 50 employees access to affordable group insurance. No eligible worker would pay more than 7.5% of their adjusted gross income on premiums to join a MediChoice plan. Workers would receive tax credits for any additional spending required to purchase the average health insurance policy in the pool. All policies will cover pre-existing conditions, prescription drugs, and provide comprehensive coverage.
Step 3: Providing Insurance Premium Assistance to Moderate-Income Families
Sixty-five percent of the uninsured have incomes less than 250% of federal poverty and are too young to qualify for Medicare. As President, Joe Lieberman will give all these workers the ability to purchase MediChoice coverage, regardless of their work circumstances. In addition, they will have access to new advanceable, refundable tax credits to help cover the cost of health insurance. Families could use their credits to purchase insurance from new MediChoice pools or the private insurance market, as long as these policies also provide reasonable benefits. This approach helps families afford coverage without restricting their choices or forcing them to change insurance plans.
Step 4: Guaranteeing That No One Loses Their Health Insurance Just Because They Lose Their Job
Today, many workers who receive health insurance through their employers worry about losing that coverage if they should lose their job. Under the current system, COBRA is too expensive or, if a company goes out of business, may not be available. And even workers moving between two jobs that both offer insurance, often face two months without insurance as they wait to enroll in new employer plans.
Joe Lieberman will ensure that all American workers have quality and affordable health care, even if they are suddenly laid off or their company collapses. His KeepCare program would provide three sources of relief for these workers. The temporary medical insurance program would require that all employer-sponsored health plans extend at least two months after an employee leaves. Employers would continue to receive tax deductions for this insurance extension. The KeepCare plan would also subsidize 65% of COBRA insurance premiums for workers between jobs, through tax credits. COBRA recipients and workers receiving Unemployment Insurance would also have access to the new insurance pools for one year.
Enhanced Care for
Seniors
Step 1: Improving the Medicare Prescription Drug Proposal
Joe Lieberman believes that the Senate-passed Medicare prescription drug plan is an important beginning that will start to answer the prayers of many seniors who are struggling to cover the rising costs of prescription drugs. But he understands the weaknesses in that plan and he intends to fix them when he becomes President – before the program goes into effect in 2006.
For example, the current bill has an enormous gap in coverage -- the so-called gdoughnut holeh --that leaves millions of seniors without the assistance they need. Premiums may vary from plan to plan. Some seniors may be forced to go round and round in a revolving door, changing between the federal fallback and private plans. And seniors covered under employer-based retiree plans would not get the protections they need. Joe Lieberman will fix these shortcomings and give seniors the coverage and peace of mind they deserve.
Step 2: Providing Assistance for Family and Long-Term Care
As America ages, families are spending more and more of their resources on long-term care and care giving. Lieberman would allow families to deduct part of the cost of long-term care insurance. Lieberman would also establish a new National Caregivers Program to support families caring for family members with chronic illnesses or disabilities.
Step 3: More Prevention in Medicare and Paying for Performance
Joe Lieberman will direct the Secretary of Health and Human Services to reevaluate Medicare to make sure it encourages doctors to help keep patients healthy, not only treat the sick. And he will put in place smart new prevention strategies designed by the Partnership for Prevention to strengthen seniorsf health under Medicare.
II. Quality and
Affordability
Joe Lieberman has long worked to reduce medical errors, improve the quality of health care, and advance medical research in America. Today Lieberman again calls on the medical and research community to raise the bar. The Lieberman plan will build upon American ingenuity to make health care more affordable through improved health care quality:
Enhancing Health Care Quality, Decreasing Health Care Disparities
Joe Lieberman will make health care more cost-effective by expanding the use of Evidence-Based Medicine (EBM). Evidence Based Medicine relies on clinical studies to determine the best approach for treating illness. EBM guidelines can help physicians choose the right treatment at the right time and, in doing so, take much of the guesswork out of medicine. But today, well-researched EBM guidelines are not always available or accessible to physicians. The New England Journal of Medicine recently reported that in some cases only 50% of Americans receive the appropriate treatment at the appropriate time. Joe Lieberman believes that is unacceptable.
Joe Lieberman will direct federal health agencies, including the Agency for Health Care Research and Quality (AHRQ), to partner with health care leaders in the private sector to better develop and disseminate Evidence Based Medicine guidelines to health care providers. This will improve the use of front-line treatments for conditions that include heart disease, diabetes, asthma, obesity, depression, and high blood pressure. A patient should know that they are getting the best care for their needs whether they are seen in a large urban hospital, their doctorfs office, or a rural clinic.
Patients also deserve the peace of mind of knowing they will not receive lower-quality care because of their race, ethnicity, gender, disability, or sexual orientation. Studies from the Institute of Medicine have indicated that this is not always the case. For example, studies concluded, gminorities are less likely than whites to receive needed services, including clinically necessary procedures.h
Joe Lieberman will build upon President Clintonfs establishment of the Center for Minority Health and Health Disparities and the Office for Research on Womenfs Health. Lieberman will promote these research entities to full-fledged research institutes within the National Institutes of Health. In addition, Joe Lieberman will provide the needed funding to reduce health care disparities, including improving availability of professional translation services for non-English speaking patients.
Working with Health Care Providers to Reduce Medical Errors
Today, we have a health system of stark contrasts. Health care in the United States saves lives by the millions, yet medical errors cause some 97,000 deaths a year and cost up to $29 billion a year, according to the Institute of Medicine. The current system of blaming medical errors on individual health professionals focuses only on one link in a long and complex chain. As is clear from the dramatic results achieved by the Veteransf Administration Health System, appropriate use of existing technologies and systems research could radically reduce our terrible error rate.
Building on his leadership in the U.S. Senate, Joe Lieberman will launch MERCY, the Medical Error Reduction Campaign, which will require mandatory, anonymous reporting of deaths and serious injuries caused by medical errors; establish a Center for Patient Safety to conduct research on medical error reduction; and create public-private partnerships to eradicate mistakes. All these steps will help America cut the medical error rate by 50 percent in five years.
Bringing Health Care Into the 21st Century
Today, the local McDonald's may have a more sophisticated computer system than your local doctor's office. Joe Lieberman will promote and facilitate expanded use of electronic medical records and the latest technology to help doctors do their jobs and help patients receive the best possible care. Unfettered communication will reduce duplicate tests, prevent dangerous drug interactions, and deliver critical information in emergencies.
To improve efficiency and guarantee privacy of individual records, Joe Lieberman will offer every American an electronic gmedical home,h where their medical records are securely stored and accessed by their providers. Patients, not health care providers, own their medical histories.
Helping the Helping Professions
Today too many health care providers, from doctors to nurses, feel underappreciated and overextended. Joe Lieberman will work to make health care a more rewarding career choice. Building on his record of working to strengthen the nursing profession, he will end mandatory overtime and enhance scholarships to educate the next generation of nurses. He will build on the improvements he has fought for in math and science education to ready more students to become allied health professionals, such as physical therapists and laboratory technicians.
Joe Lieberman will also fight for sensible medical malpractice reform that is fair to both patients and practitioners. Today, some of our most experienced clinicians are retiring early when we need them most -- and that hits the poorest patients the hardest. When Americans are hurt by medical negligence, there needs to be accountability -- and victims need to be made whole. But good doctors should not be driven out of business by skyrocketing malpractice premiums, or practice expensive, defensive medicine for fear of litigation.
Creating the American Center for Cures
America is home to the most advanced medical research system in the world -- which has produced stunning scientific breakthroughs in recent years. But it is still struggling to find cures to our most persistent and costly diseases, like cancer, diabetes, heart disease and depression. According to the Centers for Disease Control:
• Approximately 100 million Americans are living with a chronic illness.
• Chronic illnesses account for almost three of every four deaths.
• Medical care costs of people with chronic diseases account for more than 75% of the nationfs $1 trillion medical care costs.
As he has previously explained in additional detail, Joe Lieberman will create an American Center for Cures, a new federal agency designed to find cures to the diseases that plague America. The Center will help translate scientific innovations into actual cures by commissioning development of novel therapies, breaking down bureaucratic barriers that slow the development of treatments, and joining forces with academia and the private sector to launch major research projects. In doing so, the Center will ensure that more of the basic research breakthroughs funded by the National Institutes of Health, the National Science Foundation, and other federal efforts become real-world solutions.
As part of this effort, Joe Lieberman will also strengthen the authority of the Food and Drug Administration to increase access to breakthrough drugs and arm Americans with better information. He will close patent loopholes, allow drug companies to file only one 30-month stay when generic competitors come on the market, and end the collusive agreements under which brand-name drug makers keep generic products off the market. And Joe Lieberman will ensure all drug advertising is fair and accurate and encourage safe and inexpensive drug reimportation from Canada.
III.
Wellness
Rebuilding the Nationfs Public Health System to Protect Our Health and Our Security
Our public health system has suffered over the last 20 years. The Public Health Foundation estimates that only 1% of our health care expenditures are dedicated to public health. But the new threats of terrorist attacks have made public health a critical priority once again. The public health community can and must have the resources to provide services to the most vulnerable citizens, enforce laws to protect the nationfs health, monitor emerging health threats, and educate the public and the health care workforce on the best ways to protect and promote health.
In the future, we will have to protect national security through providing health security. In the modern world of unknown biological, chemical, and nuclear terrorist threats and the emergence of new infectious illnesses such as SARS, Monkeypox, West Nile Virus, and HIV we need to be better prepared to protect our communities. A strong public health system can coordinate public resources, such as law enforcement, private health care providers, schools, and the media to mount the most effective and rapid response to health crises.
Joe Lieberman will support both the Centers for Disease Control and Prevention and state and local health departments, increase funding for community health centers, and strengthen the training of the next generation of public health providers and researchers.
Re-Inventing Care for Chronic Illnesses Through Disease Management
Joe Lieberman believes we need to rethink how we go about caring for older Americans and for those of all ages with chronic conditions. The challenge is to find innovative, cost-effective methods of organizing and delivering high-quality health care that responds to the needs of those afflicted with chronic diseases. Currently, health plan financing arrangements often emphasize acute care while excluding the kinds of services needed by people living with chronic conditions.
For example, nine out of every ten people with clogged arteries continue to have high cholesterol despite the fact that reducing it can cut death and disability rates in half. People with chronic illnesses often must see several physicians in the course of a year for the management of their conditions. The result is that too often care is poorly coordinated, redundant, and lacks continuity. Providers need the flexibility to better coordinate care.
Joe Lieberman will set a simple goal: every patient with a chronic illness should be able to choose a doctor who coordinates their care, engages them as a participant in their care, and agrees to be accountable for the quality of their care. To achieve this goal, he would encourage private insurers to invest in disease management strategies and give the Department of Health and Human Services more responsibility and flexibility to become a proactive manager of federally sponsored health plans, instead of a reactive regulator. For example, local administrators could be held responsible for health improvements using provider and institutional level performance data, which is matched against evidence-based practices and benchmarked best outcomes. Medicare and Medicaid strategies could reflect these new priorities.
While Joe Liebermanfs American Center for Cures will help deliver the cures to the chronic diseases that afflict Americans, millions could live better and longer if we simply made better use of what we already know.
Providing Better Care for Mental Health
Mental illnesses constitute the second-leading cause of disability and premature death in this country. Yet about one out of every two people who needs mental health treatment gets it.
The lack of affordable mental health treatment is estimated to cost the business community at least $70 billion/year, mostly in the form of lost productivity and increased use of sick leave. Reductions in state funding for mental health care have resulted in a massive cost shift of care to the criminal justice system.
Joe Lieberman believes that the federal government
must lead the way toward providing non-discriminatory
mental health care. That starts by making Medicare fair.
Medicare currently pays only 50% of costs for
psychiatric care while covering 80% of the costs of care
for other medical illnesses. Joe Lieberman will require
Medicare, MediKids, MediChoice and all employer-based
insurance to include mental health and substance abuse
in parity with other medical conditions.