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Fam Pract Manag. 2000;7(10):11

I wanted to give you a heads up: The American Academy of Family Physicians is preparing a paper on universal coverage for health care, which should be published soon, if it's not already available by the time you read this. This is part of a two-year effort that may result in new Academy policy, and what's coming out now is a paper designed to stimulate discussion and comments from family physicians and others before it turns into policy.

Do you remember the Academy's “Rx for Health” policy from the early days of the Clinton health care reform era? If so, and whether you remember it with nostalgia or loathing, this is your chance to speak up on an issue that is likely to become increasingly important in the nation as a whole over the next few years.

Guidelines to a plan

The AAFP Task Force on Universal Coverage recommended in September that the Congress of Delegates approve several principles it felt should be embodied in any universal coverage proposal the Academy offered. While declining to accept them as principles, the Congress of Delegates did accept them as guidelines for further discussion. These are the guidelines:

  • Acknowledging that the current U.S. health care system is fundamentally flawed, we are committed to work for its reformation. In developing a new health care system, we as a society must respect the moral imperative of providing ethical health care to individuals, while providing responsible stewardship of community resources.

  • The health care system in the United States will provide basic health care to all people within the U.S. borders and eliminate financial barriers to such care. The system will be sensitive to geographic (e.g., urban, rural) and cultural diversity.

  • A uniform, outcomes-based package of basic health services will be available to all. Basic services will be defined through an explicit process. Financing for these services will be a shared public/private cooperative effort.

  • Health care services will be funded only when they are evidence-based, high-quality and cost-efficient. There will be a rational approach to end-of-life care, with attention to dignity and compassion.

  • Since there will be no financial barriers to obtaining basic health services, they will be fully funded for all. The system will allow individuals to purchase services not included in the basic coverage or to obtain insurance for these services.

  • The system will balance the needs of the individual patient with the greater good of the community as a whole. Utilization of resources within the system will be sensitive to the reality of fiscal limitations. Toward this end, the system will be designed to appropriately and efficiently manage utilization of expensive medical technology.

  • Sufficient funds will be available for public health, research and medical education to meet the nation's needs.

  • In order to maximize funding for basic health services, the system will be designed to minimize administrative costs.

So what's the plan?

I can't give more than a taste of the discussion paper; you'll have to read it yourself. But I can give you a sense of the broad outlines:

  • The program would cover services most people could be expected to use frequently. It wouldn't normally cover other services, but it would include catastrophic coverage.

  • The basic benefit package would be the same across the country, and it would be defined by an “explicit, evidence-based process” — perhaps something modeled on the processes used in Oregon and Washington to determine benefit packages for state programs, although the task force did not describe a process.

  • The program would be financed chiefly by federal payroll taxes, with employers — all employers — paying two-thirds and employees one-third.

  • The program would be administered not by the federal government but by the states, with each state free to determine how to deliver the basic benefits.

  • Basic benefits, whatever they are determined to be, would be available without co-payments or deductibles.

  • Rather than a government bureaucracy, the plan would have an oversight body more on the model of the Federal Reserve Board.

If anything here strikes you as a masterstroke, or if anything here sets your teeth on edge, the time to comment is coming soon. But please, before you do comment, read the paper and think about it. (When the paper appears, we'll tell you in FPM how to get a copy. It will also be available through the Academy's Web site at Don't react to my bare-bones summary, though. This is too important an issue for shooting from the hip.

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