Bradley's Common-Sense Plan for Health Care Reform

Nearly 45 million Americans face excruciating everyday choices about perhaps the most important aspect of their lives—their health. A young man may opt to ignore the unrelenting pain in his stomach because he can’t afford an expensive doctor’s visit. Parents may have no choice but to bankrupt their family in order to pay for the treatment of their child’s serious illness. These are the kinds of decisions that nearly one out of every six Americans must make because they are uninsured in the richest nation in the world.  

Bill Bradley’s frustration with the U.S. health care system that has abandoned so many of its citizens is palpable in The New American Story, his new book of policy ideas for making a “better, stronger, truer country.” Bradley’s prescription for health care—a “hybrid” approach combining government subsidies, private plans, and a focus on prevention—finds its roots in a vision for reform the Center for American Progress has long advocated. Like CAP’s Plan for a Healthy America Bradley envisions a nation where all Americans enjoy guaranteed, affordable health coverage.  

The talent of American doctors and the excellence of our technology may mean that the United States has the best health care in the world, but our health care system is in a dismal state. “We spend nearly twice as much per capita on health care as Germany and Canada do,” Bradley writes, yet America ranks 28th in the world on infant mortality, 31st in life expectancy, and we top the charts on obesity. Our health care spending isn’t just large, it’s also growing: between 2015 and 2020, health care expenditures are expected to reach 20 percent of the nation’s gross domestic product.  

These ever-escalating costs mean that Americans who don’t receive health coverage through their employers or through public health insurance programs are left without affordable coverage. Preventable tragedies are the result: the Institute of Medicine estimates that 18,000 people die every year because they lack health coverage, and thus go without care that could have saved their lives.  

How can we fix the broken health care system? Bradley’s vision for universal coverage clearly is founded on the ideas CAP has put forth in its health care policy platform, the Plan for a Healthy America.  

First, to ensure affordable health care for everyone, CAP advocates that we build on the pillars of the current system—public programs and private plans. We would expand and simplify Medicaid eligibility, while simultaneously using what Bradley calls a “hybrid” approach—government subsidies to enable coverage through private plans—for individuals who do not qualify for Medicaid coverage. Individuals would be given subsidies for private insurance coverage based on their income and delivered through tax credits. Access to affordable care also would be improved through the creation of a new group insurance pool similar to the Federal Employees Health Benefits Program.  

Under CAP’s plan, this new purchasing pool would provide a new opportunity for individuals, small businesses and large businesses to buy affordable coverage. Through this pool, income-based tax credits to subsidize premiums, expanded access to Medicaid, and existing employer-based coverage arrangements, everyone will have affordable options for health coverage. Once these options are in place, everyone will be required to have coverage. Bradley also supports this type of requirement. “It must be mandatory for all Americans to have health insurance,” he writes in The New American Story: “low income cannot be an acceptable barrier.”  

Beyond ensuring guaranteed health coverage for all Americans, CAP’s vision for health care reform places great emphasis on fixing the broken elements of the nation’s health care system, particularly the issues of ever-escalating health care costs and rampant inefficiency. Bradley endorses a health care plan that reigns in runaway costs. “Some estimates have put total annual administrative costs in our health system as high as $300 billion,” he writes—noting that anyone who has recently seen a doctor would recognize the red tape and lack of coordination that plague our health care system. Public investments in comparative effectiveness research, which identifies the best therapies, drugs and devices for a given health condition, and new public incentives for the expanded use of health information technology, such as personal electronic health records and computerized physician order-entry systems, would greatly improve the value we receive for our health care spending by improving quality, targeting appropriate care, and reducing administrative costs.   

Bradley, echoing CAP’s proposals, says that another important way we can control costs—and make sure we improve our health, not just our health care system—is by making prevention a national priority. Adults receive only half of recommended clinical preventive services, and most adults lack the tools they need—such as supports for improving their diets, quitting smoking, or starting an exercise program—to improve their health. We need to focus on preventive care in doctors’ offices and in our communities.

Last October CAP proposed a Wellness Trust that makes prevention a centerpiece of practical health care reform—a way to improve Americans’ health and help cut soaring health care costs. “Health care should be a right,” Bradley writes in The New American Story. “But rights come with responsibilities attached. Individuals must take responsibility for their own health by how they behave.” If we all try to be healthier—and if our government helps us reach that goal—then we can stop putting unnecessary strains on our health system due to avoidable illnesses. 

We can and must achieve affordable health coverage for all Americans. The proposals laid out by the Center for American Progress and embraced by Bill Bradley are common-sense, practical strategies for how we can make this happen.