<br><span class="gmail_quote">From: <b class="gmail_sendername">Anja Rudiger</b> <a href="mailto:anja@nesri.org">anja@nesri.org</a><br></span>
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<p><font face="TTE1C1F588t00" size="3"><span style="FONT-SIZE: 12pt; FONT-FAMILY: TTE1C1F588t00"> </span></font></p>
<p><font face="TTE1C1F588t00" size="3"><span style="FONT-SIZE: 12pt; FONT-FAMILY: TTE1C1F588t00">Ten Health Care Financing Principles to Ensure</span></font></p>
<p><font face="TTE1C1F588t00" size="3"><span style="FONT-SIZE: 12pt; FONT-FAMILY: TTE1C1F588t00">Universality, Equity, and Accountability</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">The goal of a healthy society is at the core of human rights principles, which place a duty on government to</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">protect everyone’s health. In the United States, this requires urgent health care reform to end the needless</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">loss of life, health, and well-being of millions of people. Although current reform plans are primarily driven</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">by a sense of economic necessity, based on cost concerns, they do implicitly share a common</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">understanding of health as a social goal. Where those proposals fall short is in assuming that these shared</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">social and financial goals can be realized as by-products of fragmented, market-based services.</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">Whether it is the systematic denial of coverage and care in the private insurance system, the price-inflated</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">private Medicare plans, the poor results of privatized Medicaid administration, or the costly Massachusetts</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">health reform, in no instance has the market succeeded in providing equitable access to quality care at a</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">cost affordable to individuals and society as a whole. Indeed, as a market good, health care is by definition</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">exclusionary, sold only to those who can pay, and readily exhaustible, depleted by private interests that</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">literally “take their cut” from available resources through profit, leaving less for the public at large.</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">A society disposed to protect both bodily and financial health requires the collective provision of health care</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">on a guaranteed and sustainable basis. In such a society, health care is treated as a public good, rather</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">than as a commodity sold in a marketplace dominated by private interests. The following ten principles for</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">financing health care </span></font><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 10.5pt; FONT-FAMILY: TTE1686CD8t00">emerge from human rights standards recognized in the United States and around the</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 10.5pt; FONT-FAMILY: TTE1686CD8t00">world. They </span></font><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">are intended to guide the design of a sustainable, cost-effective system that secures</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">comprehensive health care for all.</span></font><font face="TTE1C1F588t00" size="2"><span style="FONT-SIZE: 10pt; FONT-FAMILY: TTE1C1F588t00"></span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="3"><span style="FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00"> </span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="3"><span style="FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">1 Focused on health: </span></font><font face="TTE1C1F588t00" color="black" size="2"><span style="FONT-SIZE: 11pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">Health care financing must be completely aligned with the central</span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="2"><span style="FONT-SIZE: 11pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">purpose of a health system: protecting people’s health.</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">The goal of a healthy society must take precedence over factors such as market imperatives, profit motives, and</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">the vagaries of policy and budget cycles. A health care system should be financed in a way that guarantees and</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">secures comprehensive health care for everyone, consisting of all preventive care, screening, information,</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">treatments, therapies, and drugs needed to protect people’s health, including mental health, dental and vision</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">care, and reproductive services.</span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="3"><span style="FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00"> </span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="3"><span style="FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">2 Universal </span></font><font face="TTE1686CD8t00" color="black"><span style="COLOR: black; FONT-FAMILY: TTE1686CD8t00">and </span></font><font face="TTE1C1F588t00" color="black"><span style="COLOR: black; FONT-FAMILY: TTE1C1F588t00">unified: </span></font><font face="TTE1C1F588t00" color="black" size="2"><span style="FONT-SIZE: 11pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">Health care financing must secure automatic access to care for everyone</span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="2"><span style="FONT-SIZE: 11pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">and avoid separating people into different tiers.</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">How health care is financed must not lead to differences in how people receive health care, either with regard to</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">access, quality, or outcomes. Everyone must be included and get automatic access to equal high quality health</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">care, guaranteed throughout their lives and appropriate to their needs. Financing mechanisms should produce a</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">unified health care system and not give rise to different tiers of access or coverage. When everyone is part of the</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">same system, and can access and use it in the same way, the system itself is stronger and more sustainable</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">since everyone benefits from supporting it.</span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="3"><span style="FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00"> </span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="3"><span style="FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">3 Public: </span></font><font face="TTE1C1F588t00" color="black" size="2"><span style="FONT-SIZE: 11pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">Health care is a public good that should be publicly financed and administered.</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">Health care is a public good that belongs to all of us, and burdens and benefits must be shared equitably by all.</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">The government has a duty to guarantee everyone equal and easy access to public goods. It can best meet this</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">obligation through public financing and administration of health care, as this minimizes the disincentives to</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">providing care that characterize the business model of private insurers. Steps toward a public system may</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">include expanding public programs such as Medicaid and Medicare, establishing a strong public insurance plan</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">option, and effectively regulating the private insurance sector.</span></font><font face="TTE1C1F588t00" color="black"><span style="COLOR: black; FONT-FAMILY: TTE1C1F588t00"></span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="3"><span style="FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00"> </span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="3"><span style="FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">4 Free: </span></font><font face="TTE1C1F588t00" color="black" size="2"><span style="FONT-SIZE: 11pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">At the point of access, health care services must be provided without charges or fees.</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">When visiting a doctor, clinic or hospital, patients should not have to pay. Health care funds should be collected</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">independent of the actual use of care, to avoid creating a barrier to care. Services must be provided based on</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">clinical need, not payment, regardless of the financing mechanism used.</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00"> </span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="3"><span style="FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">5 Equitable: </span></font><font face="TTE1C1F588t00" color="black" size="2"><span style="FONT-SIZE: 11pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">Health care financing must be equitable and non-discriminatory.</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">Finances for health care provision must be raised and spent in an equitable way. General progressive taxation</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">constitutes the most equitable mechanism, followed by sliding scale social insurance contributions. Whichever</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">model the government adopts, financial contributions from individuals must be according to ability to pay, in order</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">to be affordable for all (e.g. on a sliding scale starting at zero). They must be assessed in a non-discriminatory</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">way, i.e. they cannot differ on grounds of health status, gender, age, employment or any other status except</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">income. </span></font><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 11pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">In a similar fashion, </span></font><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">corporations should be required to contribute to the costs of the health care system.</span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="3"><span style="FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00"> </span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="3"><span style="FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">6 Centered on care: </span></font><font face="TTE1C1F588t00" color="black" size="2"><span style="FONT-SIZE: 11pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">Care should be financed as directly as possible, without intermediaries.</span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="2"><span style="FONT-SIZE: 11pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">Insurance coverage, if used as a vehicle for financing care, works only if</span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="2"><span style="FONT-SIZE: 11pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">based on the principle of risk and income solidarity.</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">The key function of a health care system is to provide care, not coverage. If insurance coverage is used as a</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">vehicle for financing care, this can only benefit all if those who happen to enjoy better health or higher incomes</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">contribute at a level that helps support the whole system, including those in poorer health or with low incomes.</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">This grounds the system in the principles of risk and income solidarity and means that insurance must include</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">everyone (guaranteed issue), spread costs and risk across society as a whole (community ratings, large pool),</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">guarantee comprehensive benefits to all, and collect contributions based on ability to pay.</span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="3"><span style="FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00"> </span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="3"><span style="FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">7 Responsive to needs: </span></font><font face="TTE1C1F588t00" color="black" size="2"><span style="FONT-SIZE: 11pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">Resources must be allocated equitably, guided by health needs.</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">Health care spending must be guided by health needs and rectify existing disparities in resource allocation and</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">infrastructure development. Resources must be used equitably for the benefit of all, while recognizing that some</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">communities and individuals may need more care and different services than others. Communities should be</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">involved in determining how their needs are met, and their participation should be fully funded.</span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="3"><span style="FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00"> </span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="3"><span style="FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">8 Rewarding quality: </span></font><font face="TTE1C1F588t00" color="black" size="2"><span style="FONT-SIZE: 11pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">Financing mechanisms must reward the provision of quality, appropriate</span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="2"><span style="FONT-SIZE: 11pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">care and the improvement of health outcomes.</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">Health care spending must reward quality, appropriate care, and improved health outcomes, rather than profitseeking,</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">marketing, unnecessary medical procedures, poor coordination, or other interests or effects not linked to</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">protecting health. If care is financed through private insurance, regulation must ensure (through measures such</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">as medical loss ratios) that resources are not diverted away from quality care. Similarly, we should reward</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">providers who focus on quality and outcomes rather than volume, deliver primary care, provide medical homes,</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">and serve communities and areas in need.</span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="3"><span style="FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00"> </span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="3"><span style="FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">9 Cost-effective: </span></font><font face="TTE1C1F588t00" color="black" size="2"><span style="FONT-SIZE: 11pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">Resources must be used effectively and sustainably to protect the health of all.</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">Financial resources in the health care system must be used for the benefit of the whole society, leaving no one</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">behind and investing in communities whose health has not kept up with that of the rest of the population.</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">Wasteful or uncontrolled spending in some areas restricts opportunities for protecting health in others, so the</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">cost-effectiveness of interventions should be taken into account (e.g. through needs assessments, global</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">budgets for hospitals, control of capital expansion and technology projects, etc.).</span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="3"><span style="FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00"> </span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="3"><span style="FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">10 Accountable: </span></font><font face="TTE1C1F588t00" color="black" size="2"><span style="FONT-SIZE: 11pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">Financing mechanisms and procedures must be accountable to the people.</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">Whether public or private, all financing mechanisms and procedures must be transparent and accountable to the</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">people for whose benefit they exist. The people have a right to participate in the oversight of financing structures,</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">and the government has a duty to ensure that financing decisions are based on the human rights principle of</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">universal, equitable health protection. Monitoring and evaluation systems, as well as appropriate public and</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">private remedies, must be put in place to enable the public to measure and oversee progress toward meeting</span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00">human rights standards.</span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="3"><span style="FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00"> </span></font></p>
<p><font face="TTE1686CD8t00" color="black" size="2"><span style="FONT-SIZE: 10.5pt; COLOR: black; FONT-FAMILY: TTE1686CD8t00"> </span></font></p>
<p><font face="TTE1C1F588t00" size="3"><span style="FONT-SIZE: 12pt; FONT-FAMILY: TTE1C1F588t00">How Reform Can Realize Our Human Right to Health Care</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">Human rights principles illuminate the social, economic, and moral aspects of our health care crisis and</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">offer guidance for developing a holistic solution.</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">If we agree on the common goal of a healthy society, we need to create a robust and sustainable system of</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">collective health care provision that guarantees that everyone can get the health care they need, regardless</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">of their ability to pay.</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">If we agree on the need to contain the health care costs faced by families, businesses, and government, we</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">need to use our limited resources as effectively as possible, accountable to all of us. We cannot afford to</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">waste them on insurance middlemen and other corporate interests that inflate prices and deplete resources</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">through bureaucracy, marketing, and profit-making.</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">If we agree on the moral obligation conferred by human rights, which entails treating every person as our</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">equal, endowed with dignity and an equal opportunity to pursue a healthy life, then we cannot exclude</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">anyone from health care, or give them inferior care, or force them to pay private gatekeepers to access</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">care.</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">Our social goal of universal health protection requires that we pursue cost containment by turning a volatile</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">market good into a sustainable public good. And only a public good can be distributed equitably and thereby</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">help us meet our moral obligation for equal treatment.</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">Health care reformers who take into account these basic principles will be able to develop a sustainable</span></font></p>
<p><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 11pt; FONT-FAMILY: TTE1686CD8t00">system that is universal, equitable, and accountable to the people.</span></font><font face="TTE1C1F588t00" size="2"><span style="FONT-SIZE: 10pt; FONT-FAMILY: TTE1C1F588t00"></span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="2"><span style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00"> </span></font></p>
<p><font face="TTE1C1F588t00" color="black" size="2"><span style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00"> </span></font><font face="TTE1C1F588t00" color="black" size="2"><span style="FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: TTE1C1F588t00">Footnotes</span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">1 International Covenant on Economic, Social and Cultural Rights, entered into force in 1976 (hereinafter ICESCR), Art. 12; The</span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">Committee on Economic, Social and Cultural Rights, </span></font><font face="TTE16A8960t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE16A8960t00">The Right to the Highest Attainable Standard of Health: 11/08/200 E/</span></font></p>
<p><font face="TTE16A8960t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE16A8960t00">C.12/2000/4 (General Comment 14) </span></font><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">(hereinafter GC 14) at pars. 8, 9, 17, 34, 51 & 53.</span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">2 ICESCR, Art. 12; GC 14 at pars. 12 (b) & 34. States must afford “equal access” to care for all persons (GC 14, pars. 34 & 35),</span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">which is threatened in a system with different access tiers — where, for example, poorer patients, in part due to different</span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">insurance options, see different doctors than wealthier patients — but strengthened significantly in a unified system that affords</span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">the same access route to all.</span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">3 The international framework allows a public, private or mixed system (GC 14 at par. 36), provided that governments fulfill their</span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">obligation to protect against private actors, such as insurers, undermining the right to health care (GC 14 at par. 33). Given the</span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">breadth of evidence that private or privately administered financing has led to inequities and disincentives to providing</span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">appropriate coverage and care, a mixed system seems more suited to reaching human rights goals in the United States, with</span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">full and equal access to private doctors and hospitals that are publicly administered and financed. </span></font><font face="TTE16A8960t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE16A8960t00">See generally </span></font><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">GC 14 at pars.</span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">33, 35, 36, 50 & 51.</span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">4 The right to health requires the removal of all barriers interfering with access to health services (GC 14 at par. 21), and payment</span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">at the point of access, however small, has been proven to deter the uptake of health care especially by poor people (</span></font><font face="TTE16A8960t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE16A8960t00">see </span></font><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">RAND</span></font><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00"></span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">Corporation, “The Health Insurance Experiment,” RAND Research Highlights 2006 ). </span></font><font face="TTE16A8960t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE16A8960t00">See generally </span></font><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">GC 14 at pars. 21 & 50.</span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">5 </span></font><font face="TTE16A8960t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE16A8960t00">See </span></font><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">GC 14 at pars. at 12, 18, 19, 21, 30, 34, 43(a), 43(e) & 51; International Convention on the Elimination of All Forms of</span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">Racial Discrimination, ratified by the United States in 1994, Article 5 (e) (iv).</span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">6 </span></font><font face="TTE16A8960t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE16A8960t00">See </span></font><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">GC 14 at pars. 12, 35 & 51.</span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">7 </span></font><font face="TTE16A8960t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE16A8960t00">See </span></font><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">GC 14 at pars. 12, 17, 37 & 43.</span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">8 </span></font><font face="TTE16A8960t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE16A8960t00">See </span></font><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">GC 14 at pars. 12, 35, 51 & 55.</span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">9 </span></font><font face="TTE16A8960t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE16A8960t00">See </span></font><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">GC 14 at pars.18, 19, 47 & 51.</span></font></p>
<p><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">10 </span></font><font face="TTE16A8960t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE16A8960t00">See </span></font><font face="TTE1686CD8t00" size="1"><span style="FONT-SIZE: 9pt; FONT-FAMILY: TTE1686CD8t00">GC 14 at pars. 17, 54, 55, 56, 57, 58 & 59.</span></font><font face="TTE1686CD8t00" size="2"><span style="FONT-SIZE: 10pt; FONT-FAMILY: TTE1686CD8t00"></span></font></p>
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<p style="MARGIN: 0in 0in 0pt"><font face="Century Gothic" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: 'Century Gothic'">The Human Right to Health Program, run jointly by NESRI and NHeLP, is developing human rights tools to support community organizations and coalitions across the U.S. in their efforts to achieve rights-based health care reform at the local, state, and federal level. </span></font><font color="navy"><span style="COLOR: navy"></span></font></p>
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