A system of healthcare for all Americans

By Ronald Williams, Chairman and Chief Executive of Aetna, the health insurer

With the presidential election almost upon us, it is time to consider how the next president and Congress can reform America’s healthcare system in the midst of a stumbling economy. Rather than using our economic challenges as an excuse for inaction, we should use them as a catalyst for change and move towards a system in which everyone can have access to healthcare at the right time, receive the appropriate care at an affordable cost and achieve the best health outcome.

This system is within our reach if we pair our ambitions for a “big fix” with sensible and practical reforms. Being practical means building on what is working for 250m people and taking the best of our employer-sponsored system while making those benefits more widely available. It also requires genuine collaboration – among political parties, the public and private sectors and the many groups that have a stake in what happens.

There is no shortage of things we need to do to fix our healthcare system, but I believe there are six sensible solutions that can immediately put our system on the road to recovery.

First, we need to transform health insurance into a moral, civic and legal obligation by instituting an individual coverage requirement. Those who can afford coverage but do not purchase it should no longer be able to shift the risks and costs of remaining uninsured on to others. Those who cannot afford health insurance should receive government assistance to enter the ranks of the insured. Getting everyone covered will lower premiums for all of us while giving people the opportunity to get the care they need.

Second, we need to put existing solutions and programmes to work by enrolling people who are already eligible for public programmes. It is shocking that 11m people – including more than 6m children – in America are eligible for but not enrolled in Medicaid or the State Children’s Health Insurance Program, which were created to serve some of the nation’s most vulnerable populations. Instead of debating how far up the income ladder to expand eligibility for these public programmes, let us focus on getting this population – one-quarter of the total uninsured – signed up for coverage.

Third, we need a truly integrated health information system that will protect and improve people’s health and their privacy, while empowering consumers with information about their own health. Information technology has revolutionised virtually every sector but healthcare. Americans deserve a 21st century healthcare system and a good place to start is to get everyone an electronic patient record to improve quality, reduce redundant tests and ensure medical professionals have complete visibility to all prescriptions and lab tests.

Fourth, we need to improve healthcare quality and value by creating a new institution dedicated to comparing technologies, practices and treatments to more quickly determine which provide the greatest value, lead to the best outcomes and help move the nation towards greater levels of prevention and wellness. We must reorient our healthcare system towards focusing on the value and quality of care.

Fifth, we need to use the tax system to the advantage of all who purchase health coverage. In fact, we need to recognise and maintain the strengths of the employer-based system, while exporting them to make other health insurance markets function better. A sensible start would be to eliminate the tax bias against those who purchase coverage in the market, without altering the current favourable treatment for employers who offer coverage. Additionally, we could use the tax system to provide incentives for small employers to offer health insurance, to give individuals incentive to purchase health insurance and to encourage consumer involvement in their own healthcare.

Finally, we need new ways to pool individuals. One of the greatest advantages of the employer-based system is large and diverse risk pools. We can share this advantage with more people by creating a regulatory framework for market-based pooling that extends beyond the employer-based system.

Getting more people covered is not only socially desirable, it also ensures that more people get the appropriate care when they need it – which improves health outcomes and saves money for everyone.

The US healthcare system faces difficult challenges. But these are not insurmountable if we, as a nation, are willing to tackle them head on.

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