Central Valley Health Policy Institute
The CAUSE Approach is the Solution
After 15 years, the CAUSE approach would result in a health care system that provides continuous care with no coverage lapses. No lapse in coverage means that once people are enrolled into the system they will remain enrolled until death. Eligibility will be truly continuous because coverage is not employment-based. Once someone is enrolled in the program they would not have to do so again; gaps in coverage would end.
After 15 years, the CAUSE approach would result in a health care system that is affordable to individuals and business. The financial burden on employers of both small and large businesses would decrease due to the fact that employers would no longer be required to pay health care premiums for employees.Premiums for workers’ compensation and automobile insurance would drop.The various revenue sources, including the financial transaction tax, would spread the financial responsibility of insurance coverage more broadly.Lack of co-pays for evidence-based services and some cost-sharing for less necessary services can remove barriers to necessary care but limit overutilization of the health care system.
After 15 years, the CAUSE approach would result in a health care system that provides universal coverage; coverage would have mandatory enrollment for everyone under the age of 65.There would be limited enrollment data, no eligibility determinations, and no re-enrollment procedures.Individuals who fail to register initially would automatically be registered when seeking services; this would make enforcement of the individual mandate easier.
After 15 years, the CAUSE approach would result in a health care system that is sustainable for the country; this will happen by having all stakeholders share in its cost and delivery. Sustainability will depend on four factors, which the plan addresses: more health care providers will be required to serve the increased number of insured, cost increases must be contained, there must be effective federal oversight, and everyone must participate; there must be a mandate that everyone is covered and automatically enrolled.
The CAUSE approach is a public plan modeled after Medicare and coupled with private plans offering wraparound and supplemental policies to pay for out-of-pocket costs, services not covered, and deductibles for services covered by CAUSE. Savings will result from: lower administrative costs from federal financing of CAUSE, having private insurance fund supplemental health coverage, and eliminating ineffective aspects of the current system. Current tax incentives for health insurance, the Medicare Advantage program and Medicare Part D with drug coverage in a redesigned Medicare Part B that allows the negotiation of drug prices with pharmaceutical companies will all be eliminated.
Costs will also be lowered by altering fee schedules and reducing economic incentives for physicians to do medically unnecessary procedures and tests. There will also be an education system that focuses on healthy habits for children and adults. In saving money found in unnecessary places, we will have more money going to patient care. Federal financing will allow for funding mechanisms to better withstand economic downturns, unlike state and local funding.
After 15 years, the CAUSE approach would result in a health care system that is effective and efficient. It will decrease unnecessary administrative costs associated with health care. The plan will cover services that will be determined by the national health board. The board will help the national quality standards to be defined, monitored and reimbursed uniformly,and create a national impetus to adopt policies that enhance prevention. The national health board will also assure cost-effective care and alter reimbursements for physicians by increasing payments for services that result in better health outcomes and reducing payments for tests and procedures not thought to improve health so incentives become aligned with quality of care.The board will receive information from state and regional boards to allow for variations in local health needs and to promote evidence-based medicine.The plan will cover everyone; the long-term viability of the Medicare system is addressed because the pool of patients using and paying into the system is the same.
CAUSE accomplishes the short- and long-term objective of making our populace healthier and it begins by covering our children. Phasing in health care reforms over 15 years ensures that we have trained enough primary care physicians and other providers to care for the newly insured. This approach will also ultimately relieve employers of the responsibility of providing health insurance to their employees, allowing businesses to better compete with other companies around the world.
This new system also will improve administrative efficiency by eliminating the workers’ compensation system’s role in providing health care coverage. It ends the need for automobile insurance to have medical coverage. This should lower workers’ compensation and automobile insurance premiums for employers and employees. The delivery of care to patients is improved by letting them go to their own physicians for care whether they are injured at work, in their vehicles, or at home. Those patients who wish for coverage services outside of the public plan have the option to buy a secondary policy through private insurance.
The CAUSE approach is unique because it preserves the choice of physician and delivery systems through each stage of implementation, including the last stage, where, although the financing is public, the delivery of care still remains private.