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Guterman 071114 Universal Coverage

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					     THE
COMMONWEALTH
    FUND




     Achieving Universal Coverage:
   Current Obstacles & Reform Options

                     Stuart Guterman
         Director, Program on Medicare’s Future
                The Commonwealth Fund

          Maryland Society of Anesthesiologists
                     Annapolis, MD
                   December 1, 2007
                                             2



  What Are the Problems?



Uninsured Rates             Costs of Care




                            Administrative
    Quality of Care Chasm
                             Complexity
   Why Does the Current Health
                                          3


 Insurance System Fail to Promote
        High Performance?
• Access to care is unequal
• Poor access to care is linked to poor
  quality
• Care delivery is inefficient
• Fragmented health insurance system
  makes it difficult to control costs
• Financing of care for uninsured and
  underinsured families is inefficient
• Positive incentives in benefit design
  and insurance markets are lacking
     THE
COMMONWEALTH
    FUND




         Unequal Access to Care:
       The Uninsured & Underinsured
Number of States with 23 Percent or More Uninsured
                                                                                                                                                                                                                                   5

Non-elderly Adults Rose from 2 to 9 in Last Six Years

                                              1999–2000                                                                                                    2005–2006
                                           U.S. Average: 17.3%                                                                                          U.S. Average: 20.1%
                                                                                                  NH
                                                                                                   NH ME
             WA                                                                                 VT                                                                                                                 NH
                                                                                                                          WA                                                                                            ME
                                 MT          ND                                                                                                                                                               VT
                                                        MN                                                                                    MT          ND
        OR                                                                                                                                                           MN
                                                                                                 NY             MA
                                                                  WI                                                 OR                                                                                        NY             MA
                       ID                    SD                                                            RI                                                                       WI
                                                                             MI                                                     ID                    SD
                                  WY                                                                                                                                                       MI                            RI
                                                                                            PA             CT
                                                            IA                                        NJ                                       WY                                                                        CT
                                                                                                                                                                                                          PA        NJ
                                             NE                                   OH                                                                                      IA
                                                                            IN                        DE                                                  NE                                    OH
              NV                                                                                                                                                                          IN                            DE
                                                                       IL              WV             MD                   NV
                            UT                                                              VA                                                                                       IL                                 MD
                                      CO                                                              DC                                 UT                                                          WV   VA
        CA                                        KS         MO                  KY                                                                CO                                                                   DC
                                                                                                                     CA                                        KS          MO                  KY
                                                                                            NC
                                                                             TN                                                                                                                           NC
                                                   OK                                                                                                                                      TN
                                                                 AR                        SC
                       AZ         NM                                                                                                                            OK             AR                        SC
                                                                       MS    AL       GA                                            AZ         NM
                                                                                                                                                                                     MS    AL       GA
                                              TX
                                                                 LA                                                                                        TX
                                                                                                                                                                               LA
                                                                                            FL
                                                                                                                                                                                                          FL
                  AK
                                                                                                                               AK



                                                       HI
                                                                                           23% or more
                                                                                                                                                                     HI
                                                                                           19%–22.9%
                                                                                           14%–18.9%
                                                                                           Less than 14%


Source: J. C. Cantor, C. Schoen, D. Belloff, S. K. H. How, and D. McCarthy, Aiming Higher: Results from a State Scorecard on
Health System Performance (New York: The Commonwealth Fund, June 2007).
Updated Data: Two-year averages 1999–2000, updated with 2007 CPS correction, and 2005–2006 from the Census Bureau’s March
2000, 2001 and 2006, 2007 Current Population Surveys.
                                                                                                                                                                                                                               6
                  Health Insurance Coverage Getting Worse
                        for Adults, Better for Children

 Percent change between 1999-2000 and                                                                             Percent change between 1999-2000 and
 2005-2006 in uninsured adults ages 18-64                                                                         2005-2006 in uninsured children under 18

                                                                                                  NH ME
            WA                                                                               VT                                                                                                                NH
                                                                                                                         WA                                                                               VT        ME
                                MT        ND
                                                     MN                                                                                      MT        ND
        OR                                                                                                                                                        MN
                                                                                              NY             MA
                                                               WI                                                   OR                                                                                     NY             MA
                      ID                  SD                                                            RI                                                                      WI
                                                                          MI                                                       ID                  SD
                                 WY                                                                                                                                                    MI                            RI
                                                                                         PA             CT
                                                         IA                                        NJ                                         WY                                                                     CT
                                                                                                                                                                                                      PA        NJ
                                          NE                                   OH                                                                                     IA
                                                                         IN                         DE                                                 NE                                   OH
             NV                                                                                                                                                                       IN                            DE
                                                                    IL              WV              MD                    NV
                           UT                                                            VA                                                                                      IL                                 MD
                                     CO                                                             DC                                  UT                                                       WV   VA
       CA                                      KS         MO                  KY                                                                  CO                                                                DC
                                                                                                                    CA                                      KS         MO                  KY
                                                                                         NC
                                                                          TN                                                                                                                          NC
                                                OK                                                                                                                                     TN
                                                              AR                        SC
                      AZ         NM                                                                                                                          OK            AR                        SC
                                                                    MS    AL       GA                                              AZ         NM
                                                                                                                                                                                 MS    AL       GA
                                           TX
                                                              LA                                                                                        TX
                                                                                                                                                                           LA
                                                                                         FL
                                                                                                                                                                                                      FL
                 AK
                                                                                                                              AK



                                                    HI
                                                                                   Decreased -7% to -2.5%
                                                                                                                                                                 HI

                                                                                   Decreased –2.4 to 0%

                                                                                   Increased 0.1% to 4%

                                                                                Increased 4.1% to 7%




Data: Two-year averages 1999–2000, updated with 2007 CPS correction, and 2005–2006 from the Census Bureau’s March
2000, 2001 and 2006, 2007 Current Population Surveys.
                                                                                                                  7

      Percent Uninsured, Children and
    Young Adults, by Poverty Level, 2005

      Percent                                 Children                                Young Adults
      Uninsured                           Age 18 and Under                             Ages 19–29
      Total                                              11%                                     30%
      <100% FPL                                          20                                      51
      100%–199% FPL                                      16                                      42
      >200% FPL                                           7                                      16




Source: S. R. Collins, C. Schoen, J. L. Kriss, M. M. Doty, and B. Mahato, Rite of Passage? Why Young Adults
Become Uninsured and How New Policies Can Help (New York: The Commonwealth Fund, updated Aug. 8, 2007).
Data: Analysis of the March 2006 Current Population Survey by S. Glied and B. Mahato for The Commonwealth Fund.
                                                                                                                  8
  Distribution of Uninsured Young Adults Ages 19–29,
      by Poverty Status and Race/Ethnicity, 2005


                                                                                     Other
                                                                                      7%

            200% FPL
             or more               Less than
               28%                                                        Hispanic                       White
                                   100% FPL
                                     41%                                    32%                          46%


                 100%–
                                                                                    African
                199% FPL
                                                                                   American
                  31%
                                                                                     15%



                          Uninsured young adults = 13.3 million


Source: S. R. Collins, C. Schoen, J. L. Kriss, M. M. Doty, and B. Mahato, Rite of Passage? Why Young Adults
Become Uninsured and How New Policies Can Help (New York: The Commonwealth Fund, updated Aug. 8, 2007).
Data: Analysis of the March 2006 Current Population Survey by S. Glied and B. Mahato for The Commonwealth Fund.
                                                                                                          9
       Lacking Health Insurance for Any Period
             Threatens Access to Care
Percent of adults ages 19–64 reporting the following problems
in past year because of cost:




Source: S. R. Collins, K. Davis, M. M. Doty, J. L. Kriss, and A. L. Holmgren, Gaps in Health Insurance:
An All-American Problem (New York: The Commonwealth Fund, Apr. 2006).
                                                                                                                             10
          One-Third of Adults Ages 19–64 Uninsured or
           Underinsured, Half of Low-Income Adults




* Underinsured defined as insured all year but experienced one of the following: medical expenses equaled 10% or more of income;
medical expenses equaled 5% or more of incomes if low-income (<200% of poverty); or deductibles equaled 5% or more of income.
Data: 2003 Commonwealth Fund Biennial Health Insurance Survey (Schoen et al. 2005b).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
                                                                                                                             11
 People with Disabilities in the Waiting Period
 for Medicare in 2007, by Source of Coverage
                                          Uninsured
                                           264,504
                                            (15%)
                                                                                  Medicaid
                           Non-Group                                              644,520
                            150,121                                                (37%)
                             (9%)




                                   Employer
                                                                           CHAMPUS
                                    567,501
                                                                            106,697
                                     (33%)
                                                                             (6%)

                 Total people currently in waiting period = 1,733,343

Note: Number of people in the waiting period was estimated using the number of SSDI awards to disabled workers, widowers,
and adult children in 2004 and 2005 from the Social Security Administration Annual Statistical Supplement (2005 and 2006).
Source: S. R. Collins, K. Davis, and J. L. Kriss, An Analysis of Leading Congressional Health Care Bills, 2005-2007:
Part I, Insurance Coverage (New York: The Commonwealth Fund, Mar. 2007).
     THE
COMMONWEALTH
    FUND




               Employer Coverage:
               Addressing the Gaps
                                                                                                                         13
  Employers Provide Health Benefits to 160+ Million Working
 Americans and Family Members (62% of Under-65 Population)

                                        Numbers in millions, 2006
                 Uninsured                                                       Uninsured
                    47.0                                                            46.4
                   (16%)                      Employer
     Military                                  163.3                               (18%)                          Employer
       3.4                                     (55%)                  Military                                     160.8
      (1%)                                                              3.4                                        (62%)
                                                                       (1%)
  Individual
     16.0                                                         Individual
     (5%)                                                            15.8
                                                                     (6%)
Medicaid
 27.9
 (9%)                                                              Medicaid
                                                                     27.9
                                                                    (11%)

       Medicare                                                          Medicare
         39.1                                                               6.4
        (13%)                                                              (2%)



               Total population = 296.7                                      Under-65 population = 260.7

Source: S. R. Collins, C. White, and J. L. Kriss, Whither Employer-Based Health Insurance? The Current and Future Role
of U.S. Companies in the Provision and Financing of Health Insurance (New York: The Commonwealth Fund, Sept. 2007).
Data: Current Population Survey, Mar. 2007.
                                                                                                                             14
          Individual Market Insurance
  Is Not an Affordable Option for Many People

 Adults ages 19–64 with
 individual coverage or who                                                          No
 thought about or tried to buy                                    Health           health         <200%          200%+
 it in past three years who:                          Total      problem          problem         poverty        poverty
    Found it very difficult or
    impossible to find coverage                        34%          48%              24%            43%            29%
    they needed
    Found it very difficult or
    impossible to find affordable                       58            71              48              72             50
    coverage
    Were turned down or charged
    a higher price because of a                         21            33              12              26             18
    pre-existing condition
    Never bought a plan                                 89            92              86              93             86




Source: S. R. Collins, J. L. Kriss, K. Davis, M. M. Doty, and A. L. Holmgren, Squeezed: Why Rising Exposure to Health Care
Costs Threatens the Health and Financial Well-Being of American Families (New York: The Commonwealth Fund, Sept. 2006).
                                                                                                                    15
          People with Employer Insurance Have More Stable
        Coverage than Those with Individual Market Insurance

     Retention of initial insurance over a two-year period, 1998–2000

         Retained initial                          One or more spells                          Other transition
         insurance status                          uninsured
                                    2%


                            12%
                                                                              26%

                                           86%                                                 53%

                                                                             21%




                              Employer                                          Individual
                              insurance                                         insurance


Source: K. Klein, S. A. Glied, and D. Ferry, Entrances and Exits: Health Insurance Churning, 1998–2000 (New York:
The Commonwealth Fund, Sept. 2005). Data: Authors’ analysis of the 1998–2000 Medical Expenditure Panel Survey.
                  The Majority of Uninsured Adults                                                                   16


                      Are in Working Families
                          Adults ages 19–64 with any time uninsured


                                                                          No worker                       At least one
  Not                                                                      in family                        full-time
currently                                     Full-time                                                      worker
                                                                             21%
employed                                        49%                                                           67%
  36%
                                                                  Only
                                                                part-time
                                                                worker(s)
                                                                  11%



              Part-time
                15%

                  Adult work status                                                 Family work status

Note: Percentages may not sum to 100% because of rounding.
Source: S. R. Collins, K. Davis, M. M. Doty, J. L. Kriss, and A. L. Holmgren, Gaps in Health Insurance:
An All-American Problem (New York: The Commonwealth Fund, Apr. 2006).
                Smaller Firms Less Likely to Provide
                                                                          17


                          Health Benefits
 Percent of firms offering health benefits




                                                                      THE
                                                                 COMMONWEALTH
                                                                     FUND


Source: KFF/HRET Employer Health Benefits Annual Survey, 2006.
     THE
COMMONWEALTH
    FUND




               Poor Access Correlates
                 with Poor Quality
19
   Previously Uninsured Medicare Beneficiaries With History of 20
   Cardiovascular Disease or Diabetes Have Much Higher Self-
   Reported Hospital Admissions After Entering Medicare Than
                       Previously Insured
      Number of hospital admissions per 2-year period




                                                                                                                       THE
                                                                                                                  COMMONWEALTH
                                                                                                                      FUND
Source: J. M. McWilliams, et al., “Use of Health Services by Previously Uninsured Medicare Beneficiaries,” NEJM
357;2, Jul 12 2007.
              Adults Without Insurance Are Less Likely                                                                            21

              to Be Able to Manage Chronic Conditions

Percent of adults ages 19–64 with at least one chronic condition*




                                                                                                                            THE
*Hypertension, high blood pressure, or stroke; heart attack or heart disease; diabetes; asthma, emphysema, or lung disease.
                                                                                                                        COMMONWEALTH
                                                                                                                            FUND
Source: S. R. Collins, K. Davis, M. M. Doty, J. L. Kriss, A. L. Holmgren, Gaps in Health Insurance: An All-American Problem,
Findings from the Commonwealth Fund Biennial Health Insurance Survey (New York: The Commonwealth Fund, Apr. 2006).
        Adults With No or Unstable Insurance Are Less
                                                                                                                             22

          Likely to Get Preventive Screening Tests

  Percent




Note: Pap test in past year for females ages 19–29, past three years age 30+; colon cancer screening in past five        THE
                                                                                                                    COMMONWEALTH
years for adults age 50–64; and mammogram in past two years for females age 50–64.                                      FUND
Source: S.R. Collins et al., Gaps in Health Insurance: An All-American Problem, Findings from the Commonwealth
Fund Biennial Health Insurance Survey, The Commonwealth Fund, April 2006.
     THE
COMMONWEALTH
    FUND




               Costs of Care
                                                                            24
      International Comparison of Spending on
                 Health, 1980–2005
             Average spending on health   Total expenditures on health
                per capita ($US PPP)           as percent of GDP




                                                                        THE
                                                                   COMMONWEALTH
                                                                       FUND

Source: OECD Health Data 2007.                                             24
       Cumulative Annual Changes in National
                                                                                                                                        25


       Health Expenditures Growth, 2000-2007

                                                                                                                                 109%


                                                                                                                                 91%


                                                                                                                                  65%




                                                                                                                                 24%




Note: Data on premium increases reflect the cost of health insurance premiums for a family of four/ The average premium increase is
weighted by covered workers. *2006 and 2007 private insurance administration and personal health care spending growth rates are
                                                                                                                                     THE
projections.                                                                                                                   COMMONWEALTH
SOURCE: A. Catlin, “National health Spending in 2005: The Slowdown Continues,” Health Affairs, January/February 2007, 143-153; J.   FUND

A. Poisal, et al. “Health Spending Projections Through 2016: Modest Changes Obscure Part D’s Impact,” Health Affairs, February
2007, w242-w253; 2000-2007 Kaiser Employer Benefits Survey
    Percentage of National Health Expenditures     26

 Spent on Health Administration and Insurance, 2003
   Net costs of health administration and health insurance
   as percent of national health expenditures




                                   a                     b                                 c
                                                                                                       *




a2002   b1999   c 2001

*Includes claims administration, underwriting, marketing, profits, and other administrative costs;        THE
based on premiums minus claims expenses for private insurance.                                       COMMONWEALTH
                                                                                                         FUND
Data: OECD Health Data 2005.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.
                                                                                                                              27
               Financial Burden for Low- and
            Middle-Income Families Is Increasing
 Percent of non-elderly adults spending 10% or more of disposable
 income on family out-of-pocket medical costs and premiums




Note: Financial burden includes out-of-pocket expenditures on premiums for private insurance and other health care        THE
services.                                                                                                            COMMONWEALTH
                                                                                                                         FUND
Source: J.S. Banthin and D.M. Bernard, “Changes in Financial Burdens for Health Care: National Estimates for the
Population Younger than 65 Years,” JAMA 296, no. 22 (Dec. 13, 2006): 2712-19.
                                                                      28
     What Does Quality Affordable Coverage
                 for All Cost?
• Additional costs
   – Expanded use of services by uninsured and underinsured
   – Increased financial assistance for those with high out-of-pocket
     costs or premiums
   – Fiscal relief to states and employers now providing coverage?
   – Administrative costs for new insurance mechanisms
• Possible savings
   – Reduced insurance overhead – e.g. public replacing private
     coverage, group replacing individual coverage; reduced
     duplication and coverage churning; insurance regulation
   – Reduced Rx and provider payment costs – e.g. Rx price
     negotiation, purchasing clout, Medicare payment rates extended
     to other populations, reduced provider administrative cost
   – Special provisions to improve quality and efficiency – e.g. primary
     care medical home, chronic care/high cost care management;
     reduced hospital admissions; evidence-based care, comparative
     effectiveness; health IT and information exchange?
• Bottom line
   – Most plans increase federal budget cost $100 billion a year
   – Some plans reduce total health spending but hard to
     reallocate savings from winners to new cover new costs
                                                               29
 Why Are New Taxes/Revenues Required?
• Winners and Losers Are Not the Same
   – Potential Winners
       • States that have already expanded coverage to
         uninsured
       • Employers with health benefits for workers and
         dependents
       • Low-income uninsured and underinsured; those with
         high out-of-pocket costs
       • Safety net providers now providing charity care
   – Potential Losers
       • Employers that don’t now cover workers
       • Those affected by cost containment provisions –
         insurers, pharmaceuticals, providers that don’t
         serve uninsured
       • Taxpayers that fund subsidies for low-income
         uninsured, high out-of-pocket costs
• Shared Financial Responsibility and Cost Containment
  Minimize Federal Budget Costs
   – But biggest potential savings come from powerful      THE


     interests
                                                      COMMONWEALTH
                                                          FUND
     THE
COMMONWEALTH
    FUND




       Making Improvements
                                                              31
             Building Blocks for
      Extending Health Insurance to All
• Individual mandate
• Shared responsibility
   – Employer financing coverage for workers or
     contributing to pool; covering young adults under
     parents’ plans
   – State and federal financing
   – Sliding scale household contributions
• Federal/state subsidies to make coverage affordable for
  low-income individuals and families
   – Expansion of Medicaid/SCHIP with federal matching
   – Sliding scale premium subsidies
• Pooling insurance risks
   – State Connector/Health Insurance Exchange
   – Federal Employees Health Benefit Plan (Congressional
     Health Plan)
   – Medicare for All
• Quality and Efficiency Provisions                       THE
                                                     COMMONWEALTH
                                                         FUND
Commonwealth Fund Commission on High
                                                                                    32


    Performance Health System:
         Levers for Change
  1. Extend Health Insurance to All                   3. Organize the Care
                                                         System to Ensure
                                                          Coordinated and
                              2. Pursue                    Accessible Care
                              Excellence in                          for All
                              Provision of Safe,     7. Encourage
                              Effective, and         Leadership,
           5. Expand the Use of            Efficient Collaboration
                                           Care           Among
           Information Technology and
                                                          Public,
                            Exchange
 4. Increase                                              Private
 Transparency and                                         Stakeholders
 Reward Quality and                       6. Develop the
 Efficiency                               Workforce to
                                Foster Patient-
                                Centered, Primary Care

                                                                                THE
                                                                           COMMONWEALTH
                                                                               FUND
                                                              33
         Getting Value for Money:
       Health System Transformation
• Transparency; public information on clinical quality,
  patient-centered care, and efficiency by provider;
  insurance premiums, medical outlays, and provider
  payment rates
• Payment systems that reward quality and efficiency;
  transition to population and care episode payment
  system
• Patient-centered medical home; Integrated delivery
  systems and accountable physician group practices
• Adoption of health information technology; creation of
  state-based health insurance exchange
• National Institute of Clinical Excellence; invest in
  comparative cost-effectiveness research; evidence-
  based decision-making
• Investment in patient-centered primary care workforce
• Health services research and technical assistance to
  spread best practices
• Public-private collaboration; national aims; uniform
  policies; simplification; purchasing power              THE
                                                     COMMONWEALTH
                                                         FUND
                                                      34
  Roadmap to Health Insurance for All:
        Principles for Reform
• Builds an essential foundation for quality and
  efficiency as well as access
• Benefits cover essential services with
  financial protection
• Premiums/deductibles/out of pocket costs
  affordable
• Coverage is automatic, stable, seamless
• Choice of health plans or care systems
• Broad health risk pools; competition based on
  performance not risk or cost shift
• Simple to administer: lowers overhead costs
  providers/payers
• Minimizes dislocation
• Financing adequate/fair/shared across
  stakeholders
                                                  THE
                                             COMMONWEALTH
                                                 FUND
        Health Reform and the
                                                    35



        Presidential Campaign
• Health policy a top domestic issue
• Universal coverage is central to high
  performance health system
   – Needs to be combined with initiation of
     effective health system reforms
• Organize the health care system around the
  patient to ensure accessible and coordinated
  care
• Align financial incentives: payment reform and
  effective strategies for enhancing value and
  achieving savings
• Pursue and raise benchmark levels of high
  quality, efficient care and enhance capacity to
  innovate and improve including IT capacity
• Ensure national leadership and public/private
  collaboration
 Health Reform and the Presidential
                                                                      36



            Candidates
• Leading Democrats:
   – Mixed private-public insurance
   – Shared financial responsibility (government, employers,
     households), individual mandate
   – FEHBP or Medicare national insurance connector
   – IT, prevention, chronic care management, comparative
     effectiveness, pay for performance, transparency
   – Finance with system reforms and repeal/expiration of high-
     income tax breaks
• Leading Republicans:
   – Tax incentives for purchase of individual insurance
   – Make employer health insurance contributions taxable
     income to employee
   – Buy insurance from any state
   – Greater state flexibility to reallocate Medicaid/SCHIP dollars
   – Tort reform, transparency, IT
                           Judging the 2008 Presidential                                                        37

                             Candidates’ Health Plans
                                           Clinton     Edwards        Obama       Giuliani      McCain Romney

 Universal Coverage                            9             9            7            4              6    4
 Use existing dollars                          4             4            4            6              6    6
 Government gets value for money               6             6            6            4              6    4
 Spending constant percent of GDP              4             3            3            4              6    4
 Consumer informed choices                     7             6            7            4              6    4
 Provider QI tools, best practices             8             7            7            3              5    3
 Providers compete on                          6             6            6            5              6    4
 quality/price
 No adverse effect on coverage or              7             8            7            5              6    4
 patients
 Coverage affordable for sickest               8             9            8            3              5    3
 Patients seek value for money                 5             4            5            6              7    5
 Patients have access to providers             8             8            8            7              8    8
 Employers help pay for coverage               8             8            8            5              6    7
 No financial hardship on                      6             5            5            9              9    8
 employers
 TOTAL                                        86            83           81           65              82   64

Note: Scale is 1-10; 10 is the best
Source: Marilyn Werber Serafin, "Judging the 2008 Health Plans," National Journal, October 26, 2007
                                                38



      Why Not the Best?
• Current directions absent policy change
  – Costs expected to go to 20% of GDP
  – More uninsured, affecting middle class
    families as well as low-income
  – More underinsured, bill problems, medical
    debt
• Aiming higher: Why not the best?
  – U.S. has the resources and expertise
  – Benchmarks for a high performance health
    system are achievable
  – Achieving consensus requires that
    everyone participate and be willing to
    come together for the greater good
                                                                39

                    Conclusion
• Health reform will be a major issue in the 2008
  presidential election
• Business/labor/consumer/senior coalitions beginning to
  lead the drive for universal coverage
• State reforms are pointing the way
• Building blocks for universal coverage
   – Individual mandate
   – Shared financial responsibility
   – Expansion of existing programs:
       • Medicaid/SCHIP
       • Medicare
       • Employer coverage (e.g. young adults)
   – Creation of state or federal purchasing pool
       • Connector/Health Insurance Exchange
       • Federal Employees Health Benefits Program
       • Medicare for All
• Will need to address quality and efficiency; achieve
                                                            THE
                                                       COMMONWEALTH


  savings as well as expand coverage
                                                           FUND
                                                                   40

Related Commonwealth Fund Publications

• J.C. Cantor, D. Bellof, C. Schoen, et al., Aiming Higher:
  Results from a State Scorecard on Health System
  Performance, The Commonwealth Fund Commission on a
  High Performance Health System, June 2007
• S. Collins, K. Davis, and J.L. Kriss, An Analysis of Leading
  Congressional Health Insurance Bills: 2005–2007,
  Commonwealth Fund, forthcoming March 2007
• S. R. Collins, C. Schoen, K. Davis, et al., A Roadmap to
  Health Insurance for All: Principles for Reform, The
  Commonwealth Fund Commission on a High Performance
  Health System, October 2007.
• S. R. Collins, C. White, and J. L. Kriss, Whither Employer-
  Based Health Insurance? The Current and Future Role of
  U.S. Companies in the Provision and Financing of Health
  Insurance, The Commonwealth Fund, September 2007.
      Visit the Fund at: www.commonwealthfund.org

                                                               THE
                                                          COMMONWEALTH
                                                              FUND
                                                               41

       Additional Commonwealth Fund
                Publications
• K. Davis et al., Slowing Growth in US Health Care
  Expenditures: What are the Options? The Commonwealth
  Fund, January 2007
• K. Davis and C. Schoen, “Creating Consensus on Coverage
  Choices,” Health Affairs (Web Exclusive April 23, 2003)
• C. Schoen, R. Osborn, M. M. Doty, et al., “Toward Higher-
  Performance Health Systems: Adults’ Health Care
  Experiences in Seven Countries, 2007,” Health Affairs,
  forthcoming.
• C. Schoen et al., “U.S. Health System Performance: A
  National Scorecard,” Health Affairs Web Exclusive,
  September 20, 2006
• A High Performance Health System for the United States:
  An Ambitious Agenda for the Next President, The
  Commonwealth Fund Commission on a High Performance
  Health System, forthcoming.
• State Scorecard on Health System Performance,
  Commonwealth Fund, forthcoming May 2007

      Visit the Fund at: www.commonwealthfund.org
                                                           THE
                                                      COMMONWEALTH
                                                          FUND

				
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