Policy Perspective:Universal Access

By universal access, we mean access for all United States residents regardless of age, health status, employment status, or income. With either a private or a public system, access can be provided by either insurance or entitlement. Access must be affirmed by ensuring that no barriers, such as the availability of competent personnel, language, and cultural congruence, exist. All served must have their dignity respected.

Our emphasis on primary care and prevention implies a major role in providing health education to enable people to become promoters of their own wellness. All health care services should be accessible as needed, with mental health services being available

as comprehensively as physical health services. Planning should be employed to minimize both over-utilization and under-utilization, and to monitor the adequacy of access through the actual use of services.

Consumers must have the right to choose their own health care providers and to participate in decisions about their care out of respect for them and their ability to exercise informed judgment in their own interest.

Looking at the total system, it should be obvious that there are major social justice issues to be overcome. Equitable financing in a private system requires spreading of risk through community rated premiums that acknowledge our interdependence and reduce our differences. The resources taken out of the community to fund health care should be returned as benefits to the community.

The premiums, deductibles, and co-payments, if any, should be scaled by everyone’s ability to pay, both to avoid barriers and as a matter of social justice. Our current system of financing primarily through employment-based premiums is extremely regressive in offering the greatest tax benefits, i.e., subsidies, to those with the highest incomes. Where our current system uses experience rating, it imposes monumental barriers to access for the least fortunate.

In making public health a fundamental national priority, we are acknowledging its practice of prevention on a community scale and its effectiveness. Twenty-five of the thirty years added to our life expectancy over the past century were added through improvements in public health.

There should be no surprise that, since we stand for empowering communities through planning, we seek the collection of relevant data to support that planning through public reporting processes in which consumers, as well as providers participate in evaluating outcomes. In the interests of accountability, consumers should be represented on all boards overseeing health care.