Tom Vilsack on Health Care
Democratic IA Governor
A: We absolutely do need universal coverage. 47 million Americans do not have health insurance coverage, which means that they donít stop getting sick; they donít stop getting health care; they actually get it in the most ineffective and expensive way: in an emergency room. We can stop that, and we can create a more efficient health care system.
But it is much more than universal coverage. It is actually incorporating wellness into the system, at every level -- from the moment a child is born. So there are ways to do this without necessarily raising the tax burden on folks and certainly on working folks. You know, when working folks hear about tax increases, their interpretation is they may be next. And I think our party can do a better job being innovative and creative. We can look inside the budget.
A: Medicareís a much more difficult issue than Social Security. First and foremost, we have to stop paying for services and we have to start paying for results. We know today because we have inadequate data about our health care system, that in some communities youíre more likely to get surgically worked on for a back injury than I might in some other community. [We should] take data and information about what works and what was the most efficient way of providing health care. Thatís one strategy.
Another strategy is to make sure that we have a long-term care system that encourages people to stay in their homes with greater dignity, provides assisted living as an alternative, and only puts folks in nursing homes when they want to be and when they need to be. You can do a substantial amount of work in that regard.
Promote Universal Access and Quality in Health Care
That more than 40 million Americans lack health insurance is one of our societyís most glaring inequities. Lack of insurance jeopardizes the health of disadvantaged Americans and also imposes high costs on everyone else when the uninsured lack preventive care and get treatment from emergency rooms. Washington provides a tax subsidy for insurance for Americans who get coverage from their employers but offers nothing to workers who donít have job-based coverage.
Markets alone cannot assure universal access to health coverage. Government should enable all low-income families to buy health insurance. Individuals must take responsibility for insuring themselves and their families whether or not they qualify for public assistance.
Finally, to help promote higher quality in health care for all Americans, we need reliable information on the quality of health care delivered by health plans and providers; a ďpatientís bill of rightsĒ that ensures access to medically necessary care; and a system in which private health plans compete on the basis of quality as well as cost.
The Governors support efforts designed to enable small employers to join together to participate more effectively in the health insurance market. In fact, Governors have taken the lead in facilitating the development of such partnerships and alliances. However, these partnerships must be carefully structured and regulated by state agencies in order to protect consumers and small businesses from fraud and abuse and underinsurance. NGA opposes attempts to expand federal authority under ERISA. The Governors have identified the prevention of such federal legislation in the 107th Congress as a top legislative priority.
States have the primary responsibility for health insurance regulation. Across the nation, Governors are working to protect consumers and patients and to properly regulate the complicated health insurance industry.
As you know, preserving and protecting the state tobacco settlement funds is the nationís Governorsí highest priority. We strongly urge you to reach final agreement and pass the conference report on the emergency supplemental appropriations bill soon, and to retain the Senate provision that protects our settlement funds from federal seizure.
Many of our state legislatures are currently in session, and some have already completed work on their budgets. Therefore, it is critical that conferees reach agreement quickly on this issue. Governors are unified in their commitment to ensuring that the funds remain in the states and that there be no restrictions on statesí ability to tailor spending to meet the needs of their citizens.
We offer our strongest support for conferees to recede to the Senate version of the bill containing the Hutchison/Graham bipartisan tobacco recoupment protection legislation.
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