- What is the Utah Health Policy Project (UHPP)? What is UHPP’s mission?
- How can I sign up for the Health Matters newsletter?
- What are the biggest challenges UHPP faces today?
- Why should I care about health system reform?
- Why reform at the state level if the federal government already has a plan?
- Does health reform mean we’ll have a Canadian or European health system?
- Public plan, single payer – what’s the difference?
- How can I separate myths from facts in the national reform debate?
- Why does UHPP have a focus on Medicaid and other public programs?
- What role do public programs have in health system reform?
- I get quality care when I visit my doctor—why is quality an area of focus for UHPP?
- Too often, terms and words are used in the reform discussions that I don’t quite understand - HELP!
- I need health insurance…what options are available for me?
- I want health system reform…what can I do to make a difference?
- What has UHPP accomplished?
What is the Utah Health Policy Project (UHPP)? What is UHPP's mission?
UHPP is a nonpartisan resource for the public, community leaders, the media, businesses, health care providers and policymakers dedicated to strengthening the health care system while working to develop proven solutions to the crisis of the uninsured and rising health care costs. Our mission is to create quality, affordable, comprehensive health care coverage for all people in Utah through research, policy development, education, and community engagement activities.
We have 4 main initiatives:
How can I sign up for the Health Matters online newsletter?
To sign up for Health Matters, UHPP's monthly online newsletter, email Jason
What are the biggest challenges UHPP faces today?
- We make no apologies for our dual emphasis on national and state reforms, yet at times it feels like these goals are in conflict, for example when state policymakers or members of Utah’s congressional delegation say that national reforms are not necessary and the state is doing just fine on its own. Utah’s health reforms are not without merit; but without significant revenue surpluses, states simply cannot attempt health reform on their own. This is because the way to bend the cost curve is through coverage, not around it.
- We prefer to work our issues ‘inside the tent,” yet there are times when having a seat at the table limits our ability to adopt critical positions on key issues;
- Our mission is on fire at the same time as local foundation portfolios are hit hard by the recession. You can help by making a generous, tax deductible donation to the UHPP.
Why should I care about health system reform?
We all have friends or family members with a health care story. Some are denied coverage because of a pre-existing condition; others are not able to afford coverage and care; while still others cannot start a small business because it means losing their health care coverage. These stories remind us that the status quo is unsustainable and that the health care crisis impacts all of us.
Skyrocketing costs hurt small businesses, making it difficult for them to lead the way to economic recovery. The number of uninsured continues to rise. Even Utahns with insurance don’t know what their plan covers or whether it will be there when they need it most. State governments are buckling under the burden of sustaining Medicaid in the face of unprecedented caseload growth. Yet, the demand for Medicaid will only grow with the continued erosion of middle class coverage in the workplace.
UHPP believes Congress and the State Legislature must work to pass comprehensive, market-based health care reforms that contain costs, increase access and ensure quality. And reforms cannot wait another year.
Why reform at the state level if the federal government already has a plan?
Health care has been a federal-state-private partnership and must continue as a partnership to be successful. The Utah Legislature is on a slow but deliberate track: spearheaded by Speaker of the House David Clark, state reforms are generally designed to reduce waste and re-align incentives throughout the system as a first step; a portion of the savings will then be re-invested in affordable coverage for the uninsured. With deficits as far as the eye can see, this approach may actually make sense at the state level.
By contrast, congressional leaders and the Obama administration believe the way to bend the cost curve and improve value is through coverage, not around it. Bending the Curve, an influential report by the Commonwealth Fund clarifies the need to bring everyone into cost-effective coverage first, so that quality improvement and cost containment measures can have the broadest possible impact. Of course, this significant upfront investment will be partially offset by savings over the long term.
Does health reform mean we’ll have a Canadian or European health system?
No. Each country is unique in how it pays for and delivers health care. There are specific, historical reasons why countries like Canada and Great Britain have single payer or socialized systems respectively. As Commonwealth Fund’s recent international comparison of health care systems makes plain, most countries have mixed or multiple-payer systems; some, like Switzerland and the Netherlands, actually have market-based systems that work well for the vast majority of their citizens.
The U.S. is the only fully developed nation without guaranteed, affordable health care for all of its citizens. Our reforms should be uniquely American: ideally they should be market-based but within clear parameters around what constitutes acceptable behavior in the insurance market (for example, insurance companies should no longer deny access or charge higher premiums because of preexisting conditions, health status, or gender).
Public plan, single payer – what’s the difference?
There is a world of difference between the proposed public plan option and single payer health care. The public plan proposal is designed to give small businesses and individuals an affordable choice where no private market alternative may exist. As such, it would stimulate healthy competition in a marketplace dominated by private insurance plans. Ideally, it would model the behavior we want to see in the private market, thereby strengthening the private market. Low administrative overhead costs may free up valuable resources, allowing the public plan to be mission driven or focused on delivering the best value at the lowest price. UHPP supports the version of the public health insurance option that would compete on a level playing field with private plans. For details on how this could work, see New America Foundation’s recent paper on the public plan option.
In a recent interview about the proposed public plan option, HHS Secretary Kathleen Sibelius said, "This is not a trick. This is not single-payer.” "That's not what anyone is talking about — mostly because the president feels strongly, as I do, that dismantling private health coverage for the 180 million Americans that have it, discouraging more employers from coming into the marketplace, is really the bad…is a bad direction to go."
Single-payer health care is best exemplified by Medicare in the U.S. and by the universal coverage plan in Canada (also called Medicare). Under both approaches the government pays for care that is delivered in the private, mostly not-for-profit sector. Doctors see patients in private practice and are paid by the government on a fee-for-service basis—the government does not generally own or manage medical practices or hospitals. Single-payer health care is distinct from socialized medicine in which doctors and hospitals work for and draw salaries from the government—as in Great Britain.
How can I separate myths from facts in the national reform debate?
It all starts with wanting to do so! See our new piece, National Health Reform: Get the Facts (August 2009). But we need to more. Arrive early at town hall meetings and make it clear: we can’t afford to wait any longer for national health reform.
Why does UHPP have a focus on Medicaid and other public programs?
Medicaid, the Children’s Health Insurance Program (CHIP), and other programs serving low-income Utahns are the most cost effective vehicle for providing coverage and care to Utah’s most vulnerable populations. Currently they are weak, underfunded and vulnerable in the face of massive increases in enrollment that are due, in turn, to the state’s worsening economic and fiscal crisis.
Our interest in Medicaid quality improvement and consumer health assistance is further motivated by the growing interest within the broader reform discussions in the systematic alignment of treatment and financing decisions with evidence-based medicine. Based on UHPP’s work on the preferred drug list and on consumer calls for assistance with claim denials, we know that Medicaid has a long way to go before it achieves this alignment. We also know that this alignment process is notably complex and delicate for the populations who rely on Medicaid for their care.
What role do public programs have in health system reform?
Health insurance and health care services are expensive. Even if the reforms are successful many Americans will not be able to afford private insurance or all the cost sharing associated with such plans on their own. Therefore, Medicaid ,CHIP, and programs that provide subsidies to those who cannot afford coverage on their own will be key to bringing everyone into the system. (see our recent opinion piece). However, in order to control costs in the larger health system, the same quality improvements, including wellness care, prevention, and medical home, must also be provided by public programs.
I get quality care when I visit my doctor—why is quality an area of focus for UHPP?
The United States generally delivers excellent care for acute and life-threatening emergencies; however, we have tremendous room for improvement in most other areas, The U.S. spends more by far on health care than any other industrialized country (health spending consumed 16% of the GDP in 2005)—yet, according to the World Health Organization the U.S. ranks 37th in overall health. . According to the Agency for Health Care Research and Quality, the quality of care in the U.S. is certainly improving, but it can be much improved…
In many areas, the report shows that the health care system is performing well. For example:
- Quality of care has markedly improved—for measures that have trend data, 20 of 57 areas have improved over time.
- The vast majority of patients are getting the care they need in many areas. For people with diabetes, most have their blood sugar and cholesterol levels checked. Most people have their blood pressure and cholesterol levels checked to help prevent or control heart disease, and 85 percent of people experiencing a heart attack receive aspirin on arrival at the hospital.
- For cancer patients, more cancers are being detected at earlier stages. As a result of investments in biomedical research, new treatment options now exist to extend the lives of individuals with cancer.
In other areas, improvement can be made, including:
- Thirty-seven of 57 areas with trend data presented in the report have either shown no improvement or have deteriorated.
- Despite the sophisticated diagnostic and therapeutic options now available, rates remain low for provision of some basic and cost-effective preventive care (e.g., colorectal cancer screening and checking for high cholesterol levels).
- Only 23 percent of persons with hypertension have it under control. Control of hypertension is essential to continued successes in reducing mortality from heart disease, stroke, and complications of diabetes.
- Half of the people with depression stop using their medicines within the first month, a far shorter time period than recommended by scientific evidence.
- In terms of patient safety, about one in five elderly Americans is prescribed medications that may be inappropriate for him or her and thus are potentially harmful.
Utah has been compared favorably to other states on quality measures and cost effectiveness, and this may be because of the dominance and/or influence of Intermountain Health Care (for details see recent SL Tribune article). As an integrated, nonprofit health care delivery system, Intermountain has been able to focus resources on aligning all treatment decisions with evidence-based medicine (for details see our recent Radio West interview with KUER). But Intermountain owns only 40% of Utah hospitals and its private insurance product, Select Health, has only 25% of covered lives.
With or without the Intermountain model, we know we can do even better at delivering higher quality care at less cost, and this is why UHPP is dedicated to promising practices in the delivery of quality, cost effective, and culturally appropriate health care. UHPP’s Quality/Equality Watch Initiative generally represents the consumer’s interest in statewide efforts to improve the quality, cost effectiveness, cultural competency, and transparency of care.
Too often, terms and words are used in the reform discussions that I don’t quite understand - HELP!
Unfortunately, you are not alone. See our Health System Reform Glossary. If you encounter a term that is not defined there, scroll all the way to the bottom and send us a request for yet another definition—we will do our best.
I need health insurance…what options are available for me?
First, see our recently updated Current Options for Health Care Coverage and Care. If you don’t find what you need there, you are not alone. The sad reality is that not enough of us qualify for affordable, quality health care coverage. As costs continue to rise, workers are being asked to pay more of the cost of care and coverage. The result is that they will lose access to cost-effective care. This is why it is so important to get involved in advocacy for health system reform.
I want health system reform…what can I do to make a difference?
UHPP has several options for you to get involved.