(Bethesda, MD)—On June 8-9, 2000, the College hosted its first "summit" on health system reform and the uninsured. The summit was the culmination of several factors: the strong encouragement of the College leadership to assume a more active role in reforming the health system, an increasingly ripe social and political environment for health system reform, and the absence of consensus among College members about the myriad issues involved with reform.

The summit was designed with a twofold purpose: 1) as an educational forum for College members and 2) to stimulate discussion that would lead to agreement on a set of narrowly defined principles to serve as the basis for a College position.

Participants were presented with questions and sample principles in advance of the meeting to stimulate thinking about issues such as incremental vs. sweeping health system reform, employment-based vs. alternative sources of health care insurance, subsidies and tax credits as financing mechanisms for the uninsured, and so forth.

Panelists Offered Valuable Perspectives
The summit was divided into two sessions. During the first session, meeting participants heard from a panel of four health policy experts who shared their expertise and views about various aspects of health system reform.
John Colmers, executive director of the Maryland Health Care Commission, spoke about the public role in the U.S. health care system. Mr. Colmers advocated an approach of balanced federalism for achieving health system reform; that is, the federal government would establish broad health system reform standards in consultation with the states, leaving implementation to the states. Mr. Colmers stressed that any significant reforms will require action by Congress and the president because of the significant barriers states face in achieving universal coverage on their own.

Speaking on the topic of the role of the private sector in health system reform was Marsha Gold, ScD, a senior fellow at Mathematica Policy Research. Dr. Gold said that the two major issues in health system reform are 1) who will provide insurance-government, employers, or individuals? and 2) how will it be delivered-if not via managed care, then how? Ms. Gold explained that the challenge is whether to opt for a "quick fix" or to address the fundamental issues facing our health care system.

Also on the panel was Len Nichols, PhD, a principal research associate at The Urban Institute. Dr. Nichols explained the pros and the cons of the current employer-based health insurance system and of an individual-based market. Dr. Nichols said that an optimal private insurance market would need to protect individuals against adverse selection and would need to include purchasing pools to provide administrative and risk-pool efficiencies. Furthermore, Dr. Nichols suggested that organizations such as the College could play a role in developing quality standards for health plans and providers as well as in data reporting and dissemination.

Winding up the panel discussion on the perspectives of health care financing was Kenneth Thorpe, PhD, chair of the Department of Health Policy and Management at Emory University. Dr. Thorpe said that voluntary efforts to extend health care coverage to uninsured adults would largely rely on government funding. Dr. Thorpe presented several ideas for financing health care insurance for more Americans, albeit in a context of federal budget surpluses. Regardless, Dr. Thorpe stated that covering the uninsured, if financed by the government, would require a substantial reduction in the price of insurance.

ACC Policy Direction, Next Steps
Following the presentations, participants posed questions and deliberated about specific principles the College should adopt. There was immediate consensus that universal coverage should be the first principle. A major area of discussion was whether the College should first adopt an incremental approach to health system reform or move to develop a specific plan. It was decided that these approaches are not mutually exclusive and that the College should develop a set of principles that are incremental and sequential (in other words, build toward overall systemic reform).

Other topics of discussion included whether the College should advocate that reforms be based on the current employer-based system of providing health insurance or some alternative system through which individuals would hold responsibility for obtaining their own coverage. The general consensus was that individuals currently receiving insurance through an employer should be left as such. However, alternate mechanisms, such as expansions of current public programs (e.g., the State Children's Health Insurance Program; joint purchasing pools [to enable small employers or individual patients to join together to increase their purchasing power]; or a Federal Employees Health Benefits Program-style system [through with individuals are presented with a menu of health plan choices, partially subsidized by the federal government]) should be considered for the low-income and unemployed uninsured.

There was also extensive deliberation about the role of health care professionals in ensuring quality and the highest value of care in the health care system. Participants agreed that this should be achieved through shared accountability on the part of purchasers, providers, and patients via measures such as promoting guidelines, monitoring best practices, and facilitating administrative simplification.

The next step will be the formation of a writing group to flesh out these principles and develop a more formal recommended position paper. The input of members of the College is valuable. To offer comments to the College as this process continues, write to Barbara L. Greenan, director of Legislative Affairs, and fax to 301-897-8757 or e-mail http://www.acc.org/media/news/aug00/mail%20to:%20advocacydiv@acc.org.