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Health-Care Reform Checklist

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By Mona Gable, Illustrations by Brian Cronin

Published Oct 1, 2009 8:00 AM


Early last year, a study by the Organization of Economic Cooperation and Development took a detailed look at the state of health care in the U.S. The results could hardly have been grimmer. Not only do Americans spend far more on health care than other developed countries such as Norway, Australia and Japan — a staggering 16 percent of our GDP — we also fare poorly on a number of important health-related measures, including infant mortality, life expectancy and obesity.

"We have much better evidence since the 1990s that the quality of care is not only not what we thought it was, but even lags behind other developed countries," says Mark Peterson, professor of public policy and political science at UCLA. "People get only about half the recommended treatment for particular conditions. We do terribly in reducing treatable deaths. Even things like hospital infections kill as many as 100,000 people a year."

These are just some of the troubling factors that have led lawmakers to consider the politically explosive goal of health-care reform. At press time, the incendiary topic was still being debated in Congress, argued in town halls and fought over in the media.

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But what's the view from the front lines of medicine, among the doctors, nurses and health-care professionals for whom this is not a political or philosophical abstract, but an intensely personal, life-and-death issue?

We canvassed members of UCLA's faculty to weigh in on reform efforts from the patient's perspective. What must a truly effective health-care checklist include to help people when they're sick — and to keep them from getting sick in the first place?

Here are their diagnoses.

Access Allowed

The experts' first action item is to extend coverage to the 47 million Americans who are uninsured. Also on the agenda: helping millions more who are underinsured — people whose coverage is so thin it puts them at grave risk if they have a medical crisis.

"You've got to cover everybody with some basic form of coverage," says Dr. Patrick Dowling, chair of UCLA's Family Medicine Department. "And the payment rate should be reasonable, as it is in Medicare."

In Los Angeles County alone, he says, 2 million people lack health insurance while another 1.7 million are on Medi-Cal, the federal-state insurance program. Yet much of that care isn't even covered. "Many physicians don't want to take Medi-Cal patients because the payment is so low," Dowling says.

Right now most Americans get their health insurance through their employers. So if they get laid off or even want to change jobs, they can lose their coverage. Insurance companies are also free to drop you, deny your claims, or jack up your premiums.

To make matters worse, "In a number of markets there are very limited choices of private plans," says Peterson, who is writing a book on the history of American health-care reform, "and about half of people with employer-sponsored [options] do not have a good choice of plans."

This is why, the Bruin experts contend, a public option — which may or may not make it into the final bill — makes the checklist. But to truly benefit patients, it would have to be accompanied by payment reform of the current fee-for-service system.

"You can't insure 47 million additional people with a public option and not have payment reform," argues Dr. Carol Mangione, UCLA professor of medicine and public health. "That would not be sustainable. We're going to need to make some hard choices about what a public option should pay for. And hopefully, those would be the things that are highly effective and known to produce quality."

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