POSITION STATEMENT
ON HEALTH CARE REFORM
Since 1915, the American Medical
Women's Association (AMWA), an organization of women physicians
and medical students, has supported improved delivery of health
care. During the current debate on how to remedy the many flaws in
the American health care system, it is important to emphasize that
the lack of universal coverage is the major impediment to the
improved health of many of the citizens of our
nation.
AMWA has testified before Congress in
support of the principles of the President's health reform plan
and Representative McDermott's single payer proposal. While we
have not endorsed a specific plan, we believe the following
principles need to be included in any plan designed to reform the
nation's health care delivery system:
Universal Coverage
Availability of health care should not be
linked to a person's employment, place of residence, age or
marital status. Necessary health care should be delivered on a
medical need basis, not on the basis of geography or financial
ability.
In May, 1994, the Congressional Budget
Office found that a partial-coverage plan would protect those with
very high or very low incomes. The working class would still be at
risk of losing health insurance coverage.
Americans need to know that the
coverage they gain under health reform will never be taken
away.
Defined
Benefits
Package Well-defined benefits
are necessary to assess the impact of a plan on the populations it
is designed to serve. Without defined benefits, the actual cost of
a plan would be impossible to determine.
Comprehensive
Care
Available care should be
appropriate to the needs of society. It should emphasize basic
primary care, prevention, early detection, chronic care, long-term
care, mental health and chemical dependency treatment, and
reproductive health services, as well as acute and specialized
care.
Financing
Mandated
employer benefits offer a practical and effective financing
mechanism.
Administrative Simplification
Simplification means that the most
direct connection, with the smallest number of bureaucratic
personnel, should lie between payment for the health plan and
payment for services. A streamlined bureaucratic oversight process
and the standardization of forms would free providers to do what
they do best: care for patients.
Choice of Provider
To the greatest extent possible, the
patient should be able to choose her/his physician. This principle
acknowledges that continuity of care is of medical value and
contributes to quality.
Physician Autonomy
Quality of patient care must be
physicians' first priority, however, physicians have to take
responsibility to make cost-conscious
decisions.
The American Medical Women's
Association recognizes both the pressing need for health care
reform, and the limited source of funding from which to draw on as
Congress begins to legislate systemwide changes to the health
delivery system. As the debate over how to finance health reform
intensitifes, it is important to remember that a majority of
Americans favor an increase in the federal excise on
tobacco.
Tobacco tax: revenue for health
reform?
Tobacco is the single most appropriate source
of revenue for health care reform. Tobacco is harmful to all users
at all doses--there is no safe level of tobacco use. It is the
only product which, when used exactly as intended, causes
addition, disease and early death.
The Congressional Joint Committee on
Taxation and the Congressional Budget Office agree that the
Clinton Administration's proposed 75-cent tax increase would
generate a total of $94 billion in new revenue in the first nine
years. The Joint Committee on Taxation predicts that a $1.76
increase will generate a total of $59 billion in new revenue in
the first three years.
Raising the tobacco tax will generate
revenue for health reform and discourage young people from
beginning the habit.
Most Americans support a tobacco tax
increase. This is a tax vote Congress can be proud to
take.
Senate Labor and Human
Resources Committee: Finished work on S 1757, a version
of President Clinton's plan on June 10. This plan includes an
80/20 employer mandate (although businesses with 10 or fewer
employees are exempt) and universal coverage. AMWA supports the
Committee's actions to retain abortion coverage as part of the
covered benefits package. A problematic amendment by Senator
Bingaman (D-NM) allows a national board to change the benefits
package if there are funding problems.
Senate Finance
Committee: Provides for universal coverage through
employer contributions. Financing relies more heavily on taxes
than President's plan: cigarette tax rased by additional $1;
handgun ammunition taxed 50%; firms of over 500 workers pay 1%
payroll tax. Employers of more than 20 workers pay 80% of
insurance costs. Firms of fewer than 20 pay payroll tax. This plan
is considered to be less regulatory than the President's.
House Education and
Labor: Subcommittee on Labor-Management relations voted
out a single payer plan (HR 3960) on June 9, which charges the
government to collect premiums and distribute benefits.
The
full Committee is scheduled to begin markup on a bill similar to
the President's on June 17, and to continue markup through the
next two to three weeks.
House Ways and Means:
Chairman Sam Gibbons (D-FL) introduced a version of the
President's plan which includes universal coverage, cost
containment, and no new broad-based taxes. The draft extends
Medicare coverage to uninsured. According to the Congressional
Budget Office, the bill would create a $23 billion budget
shortfall over five years.
House Energy and
Commerce: The Committee needs one more vote in order to
pass legislation containing an employer mandate. Neither
Representative Cooper (D-TN) nor Representative Slattery (D-KS)
have indicated that they are willing to change their positions and
support a mandate. Without at least one of these two votes,
Chairman Dingell can either do nothing or pass a bill of
incremental reforms.
