Health Affairs, 25, no. 2 (2006): 566 doi: 10.1377/hlthaff.25.2.566 © 2006 by Project HOPE	New Online   Senate Health Reform Bill   Rewarding Providers   Public Option Policy Brief   Health Reform & Abortion   Delivery System Reform

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Letters

Reform Before Calamity

For readers dismayed by that menu of catalysts, they offer up another scenario: that reform might be impelled by a combination of factors, such as widespread unhappiness in the business community with the trajectory of employer-sponsored coverage; states’ inability to keep up with the budgetary obligations imposed by health care entitlements; and a fiscal crisis in Medicare.

A few observations: (1) In most countries that have managed to construct universal health care systems, that achievement was not precipitated by cataclysms exogenous to their prior health care arrangements. (2) The potential confluence of catalyzing circumstances that the authors posit as an alternative scenario is already emerging. (3) Other sources of pressure for reform are becoming more active and insistent in their advocacy, including pension and health funds; religious congregations; health care providers; and unions.

The country’s biggest and broadest alliance of organizations working for systemwide health care reform—the National Coalition on Health Care—has doubled in size during the past few years. Collectively, our member organizations now represent about 150 million Americans.

The coalition has issued ambitious recommendations to achieve universal coverage, slow increases in health care costs, and improve the quality of care. In addition, we recently commissioned and issued a careful analysis by Ken Thorpe of the costs and huge savings associated with our recommendations.

Organizationally and analytically, there is a strong base to build on, as well as a strong basis for believing that health care reform can be attained without a precursory calamity.

Henry E. Simmons

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