Affordable, Quality Health Care for All by 2012?

The Citizens' Health Care Working Group, a nonpartisan government organization established through the Agency for Healthcare Research and Quality, has published a set of interim recommendations designed to address problems in the U.S. health care system from a variety of perspectives, with a goal of having a set of "appropriate and affordable health care services" in place by 2012. While the recommendations do not pertain to any specific health care profession or class of providers, all members of the chiropractic profession are encouraged to review and comment on the recommendations, which can be accessed for free on the working group's Web site, www.CitizensHealthCare.gov.

The Citizens' Health Care Working Group was created through a provision included in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, as a means of giving Americans the opportunity to engage in a national debate about the types of health care services they want covered, what level of health care coverage they want, how coverage should be financed, and what types of concessions they would be willing to make to ensure access to high-quality care. The group's main purposes, according to the act, are to "provide for a nationwide public debate about improving the health care system to provide every American with the ability to obtain quality, affordable health care coverage," and to "provide for a vote by Congress on the recommendations that result from the debate."

While no members of the chiropractic profession currently serve on the working group, the American Chiropractic Association is one of more than 30 health care agencies and trade groups that have pledged their official support for the organization. Currently, the group also has the official support of more than two dozen members of Congress, including Iowa Senators Charles Grassley and Tom Harkin, both longtime proponents of chiropractic.

Published on the working group's Web site on June 1, 2006, the interim recommendations, which reflect the opinions of more than 20,000 people who have participated online and in community meetings since the group's formation, outline a plan for helping to achieve broad-based change in the American health care system. At present, the working group has established six recommendations, with the goal of providing all Americans access to "a set of affordable and appropriate core health care services" by 2012. Among the recommendations:

• Making a public policy that all Americans have affordable health care. All Americans will have access to a set of core services, with financial assistance available to those who need it.
• Defining a "core" benefits package for all Americans. The group recommends the creation of an independent, nonpartisan, public/private group to identify what benefits should be covered, and to make additional recommendations as needed. In addition, the group recommends that "immediate action" be taken to ensure that the "most vulnerable" parts of the population have access to necessary core benefits.
• Guaranteeing financial protection against exceedingly high health care costs. The group recommends that a national program be created which ensures coverage for all Americans; protects against high out-of-pocket medical costs; and offers financial protection for low-income individuals and families as well.
• Development and expansion of integrated community health networks. The group recommends that the federal government lead a national initiative to develop and expand integrated public/private community networks of health care providers, aimed at providing "vulnerable populations" with a source of high-quality care.
• Creating and advancing efforts to improve quality of care and efficiency. The group recommends that the federal government use federally funded programs such as Medicare, Medicaid and the Veterans' Health Administration to develop and implement strategies aimed at improving quality and efficiency of care, while at the same time controlling costs across the entire health care system.
• Restructuring the ways in which palliative care, hospice and other services are provided and financed. Individuals nearing the end of life, as well as their families, need support from the health care system to understand their health care options, make their choices about the delivery of care known, and have those choices honored. To achieve this, the group recommends that public and private programs support training for health professionals that emphasizes proactive, individualized care planning and clear communication between providers, patients and their families. The group also recommends that funding be made available for support services to assist individuals and families in accessing the kind of care they want during their final days.

Public Comment Period Now Open

The public comment period to the working group's interim recommendations officially ends Aug. 31, 2006. Once the comment period has ended, the working group is required to submit a final set of recommendations to Congress and the president. Within 45 days of receiving the final recommendations, the president must submit to Congress a report containing additional views and comments, along with recommendations for legislative and administrative actions the president considers appropriate. The act also designates five congressional committees (the Senate Finance Committee, the Senate Health, Education, Labor and Pensions Committee, the House Ways and Means Committee, the House Committee on Energy and Commerce, and the House Committee on Education and the Workforce) to hold hearings on the president's report as well as the working group's recommendations.

All interested parties are encouraged to read the working group's interim recommendations and submit their comments before the Aug. 31 deadline. Comments may be submitted online at the www.CitizensHealthCare.gov; by regular mail (Citizens' Health Care Working Group, ATTN: Interim Recommendations, 7201 Wisconsin Avenue, Suite 575, Bethesda, MD 20814); or by e-mail to citizenshealth@ahrq.gov. Additional information about the recommendations, the process used to seek public input, and findings from the group's previous meetings and online polls also can be found at the above-noted Web site.