We recently witnessed the entry of yet another health reform bill, this time from Republicans promising, among other things, preservation of employer-based insurance.  This echoes President Obama’s similar pledge. Such rare bipartisan agreement is consistent with polls showing that most Americans are happy with their health insurance, just not its cost.

Unfortunately, that’s like a third of all Americans saying they’re happy about being obese, just not about its health risks. You can’t have one without the other.  The fact is that employer-based health insurance is, inherently, a big cause of our health care problems—so is Medicare.  I’ll go into more detail on the fundamental failings of both programs in subsequent postings.

Right now I want to focus on a more basic question: what are the goals we want health reform to achieve?  Trying to preserve one particular form of insurance, whether employer or government-sponsored, is not one of them. Allowing everyone to obtain affordable health insurance is.  Getting health care costs under control is not by itself a goal.  Getting sustainable quality and affordability is.

My point is this: if we don’t carefully define our goals, we won’t be able to evaluate anybody’s proposed solution and we won’t like what we end up with.  So I’d like to draw a line in the sand and propose eight essential goals for American health reform:

  1. Universal insurance availability: Everyone in America should have access to affordable health insurance, regardless of individual health status, history, or genetics.
  2. Sustainable value and affordability: We must get spending under control while improving quality and promoting innovation—all on a sustainable basis.
  3. Free-rider prevention: No one should be allowed to game the system by delaying insurance purchases until they become ill.
  4. Voluntary participation: Buying health insurance should be voluntary, as is the purchase of everything else we buy.
  5. Financial protection: Health insurance should protect people against the unaffordable costs of necessary medical care.
  6. Individual choice of insurance, providers, and treatments: Everyone should be able to choose the vendors that best meet their own needs, priorities, and circumstances.
  7. Portability: People should be able to keep their own health insurance regardless of employment status or eligibility for government-sponsored coverage.
  8. Personal responsibility for prevention: People must be responsible for managing their own health risks like obesity, smoking, blood pressure, cholesterol, and blood sugar.

I believe we can attain all these goals in the United States, but it won’t come from any of the current proposals in Congress—from either side of the aisle. That’s not surprising, since there isn’t a single country in the entire world that has ever delivered on all eight.  But this is America, damn it, and we’re used to resolving seeming insoluble problems. We can certainly do it with health care. I explain how in my book Cured! and will do so on this website.

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  1. Ashley says:

    Great post! I am only 26 and think this sort of material and information in highly valuable for our generation.

  2. Anonymous says:

    These are some ambitious goals. Hopefully they will see the light of day.


  3. Pingback: Stephen S.S. Hyde Compares the Health Reform Proposals | Stephen S. S. Hyde On Health Care Reform Topics

  4. Barbara Spinks says:

    I am one of thousands of people who can not really understand all of the different proposals for healthcare reform. I cannot even understand insurance policies, if I try to read them, which has left me dependent on those telling the story from a democratic or republican viewpoint. After trying to understand, the only thing I could determine was, that there is no way to fix the healthcare system. After reading a portion of your proposal, I had an Ah-Ha moment. I wish that you had the same stage as the politicians because I think a lot of regular people like me would “get it” ! Good luck in trying to get your message to the American people…..it has given me hope that there might be a solution. Thanks for your efforts. Barbara Spinks

  5. Daniel says:

    Of course there hasn’t been a nation that has achieved all eight goals because not every nation has set out to achieve all eight of them.

    Canada does not attempt to achieve goals #3, #4, or #8. They’re far more interested in #1, #2 and #5. #7 becomes a moot point in a single-payer system. And yet they spend far less on their health care than we do in the United States. (You might argue that they don’t achieve #6 very well.)

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