Positions on Social Policy
POSITION IN BRIEF
Promote a health care system for Hawaii that provides access to a basic level of quality care for all Hawaii residents and controls health care costs.
The LWV of Hawaii believes that a basic level of quality health care at an affordable cost should be available to all Hawaii residents. Other Hawaii health care policy goals should include the equitable distribution of services, efficient and economical delivery of care, advancement of medical research and technology, and a reasonable total state-wide expenditure level for health care.
The League believes it is necessary to preserve the physical, chemical and biological integrity of the ecosystem, with maximum protection of public health and the environment, ** (taken from the LWVUS position on Natural Resources).
Basic Level of Care:
Every Hawaii resident should have access to a basic level of care that includes the prevention of disease, health promotion and education, primary care (including prenatal and reproductive health), acute care, long term care and mental health care. Dental, vision and hearing care also are important but lower in priority. The League believes that under any system of health care reform, consumers/patients should be permitted to purchase services or insurance coverage beyond the basic level.
Financing and Administration:
The League favors a national health insurance plan financed through general taxes in place of individual insurance premiums. As the U.S. moves toward a national health insurance plan, an employer-based system of health care reform that provides universal access is acceptable to the League. The League supports administration of the U.S. health care system either by a combination of the private and public sectors or by a combination of federal, state and/or regional government agencies.
The League is opposed to a strictly private market-based model of financing the health care system. The League also is opposed to the administration of the health care system solely by the private sector or the states.
The League supports increased taxes to finance a basic level of health care for all Hawaii residents, provided health care reforms contain effective cost: control strategies.
The League believes that efficient and economical delivery of care can be enhanced by such cost control methods as:
- reduction of administrative costs
- state planning for the allocation of personnel, facilities and equipment
- establishment of maximum level of public reimbursement to providers
- malpractice reform
- use of managed care
- utilization review of treatment
- mandatory second opinions before surgery or extensive treatment
- consumer accountability through deductibles and copayments
The League believes that health care services could be more equitably distributed by:
- allocating medical resources to underserved areas
- providing for training health care professionals in needed fields of care
- standardizing basic levels of service for publicly funded health care programs
- requiring insurance plans to use community rating instead of experience rating
- establishing insurance pools for small businesses and organizations
Allocation of Resources
The League believes that the ability of a patient to pay for services should not be a consideration in the allocation of health care resources. Limited resources should be allocated based on the following criteria considered together: the urgency of the medical condition, the life expectancy of the patient, the expected outcome of the treatment, the cost of the procedure, the duration of care, the quality of life of the patient after treatment, and the wishes of the patient and the family.
In 1990, the LWVUS undertook a two-year study to examine policies for the funding and delivery of health care in the United States. The study was divided into two phases - Phase I would study the delivery and policy goals of the U.S. health care system, and Phase II would focus on health care financing and administration choices. The LWVUS announced its initial health care position in April 1993.
The health care position outlines the goals the LWVUS believes are fundamental for U.S. health care policy. These include policies that promote access to a basic level of quality care at an affordable cost for all U.S. residents and strong cost control mechanisms to ensure the efficient and economical delivery of care. The Meeting Basic Human Needs position also addresses access to health care.
The new health care position enumerates services League members believe are of highest priority for a basic level of quality care: the prevention of disease, health promotion and education, primary care (including prenatal and reproductive health care) acute care, long-term care and mental health care. Dental, vision and hearing care are recognized as important services but lower priority when measured against the added cost involved. Comments from numerous state and local League, however, emphasized that these services are essential for children. Results of consensus taken in Hawaii mirror what was finally adopted as national position on Health Care, 1992.
Millions of Americans cannot meet their basic health care needs due to factors such as geographic location, sex, race, culture or socioeconomic status. To achieve more equitable distribution of services, the League endorses increasing the availability of resources in medically undeserved areas, training providers in needed fields of care, standardizing the services provided under publicly funded health care programs and insurance reforms.
The LWVUS health care position includes support for strong mechanisms to contain rising health care costs. Particular methods to promote the efficient and economical delivery of care in the United States include state (regional) planning for the allocation of resources, reducing administrative costs, reforming the malpractice system, copayments and deductibles and using managed care. In accordance with the position's call for health care at an affordable cost, copayments and deductibles are acceptable cost containment mechanisms only if they are based on an individual's ability to pay. In addition, cost containment mechanisms should not interfere with the delivery of quality care.
The position calls for a national health insurance plan financed through general taxes, commonly known as the "single payer' approach. The position also supports an employer-based system that provides universal access to health care as an important step toward a national health insurance plan. The League opposes a strictly private market-based model of financing the health care system. With regard to administration of the U.S. health care system, the League supports a combination of private and/or regional agencies. The League supports a general income tax increase to finance national health care reform.
The LWVUS strongly believes that should the allocation of resources become necessary to reform the U.S. health care system, the ability of a patient to pay for services should not be a consideration. In determining how health care resources should be allocated, the League emphasizes the consideration of the following factors, taken together: the urgency of the medical condition, the life expectancy of the patient, the expected outcome of the treatment, the cost of the procedure, the duration of care, the quality of life of the patient after the treatment and the wishes of the patient and the family.
In spring 1992, the LWVUS sent members of the 102 Congress, a memorandum announcing the League Phase I position and urging prompt congressional action to address the health care crisis. The LWVUS Lobby Corps also urged members of Congress to support the League's position. As the LWVUS was completing Phase II of the study, the issue of health care reform was rising to the top of the country's legislative agenda. In April 1993, as soon as the study results were announced, LWVUS President Becky Cain met with White House Health Care Task Force officials to present the results of the League's position. Since then, the League has actively participated in the health care debate.
The LWVUS testified in fall 1993 before the House Ways and Means Subcommittee on Health, the Energy and Commerce Committee and the Education and Labor Committee, calling for comprehensive health care reform based on the League position. The Lobby Corps visited all Senate and House offices with League's support for comprehensive health reform and opposition to legislative proposals that fell short of comprehensive reform. In September, the League joined two coalitions - one comprised of consumer, business, labor, provider and senior groups working for comprehensive health care reform, and the other comprised of groups supporting the single-payer approach to health care reform.
Throughout 1994, the League actively lobbied in support of comprehensive reform, including universal coverage, cost containment, singlepayer or employer mandate and a strong benefits package. The League continued to advocate for the inclusion of the state single-payer option in any health care package and emphasized LWVUS support for the inclusion of reproductive health care, including abortion, in any health benefits package. League leaders participated in countless lobbying visits in Washington - including Convention '94s Day on the Hill - held grassroots meetings with members of Congress and spoke out in the media through press conferences, radio talk shows, editorial board meetings and speeches.
Health care reform advocates, including the League continued to press for comprehensive health care reform through September 1994. But congressional sponsors were unable to reach accord and comprehensive reform was declared dead for the 104th Congress. The focus then shifted to the states, where Leagues have worked in support of health care reform at the state level, while fighting off attempts to cut back on existing health care.
The LWVEF initiated community education efforts on health care issues with the "Understanding Health Care Policy Project" in the early 1990s. The project provided training and resources for Leagues to conduct broad-based community outreach and education on health care policy issues with the goal of expanding community participation in the debate.
In spring 1994, the LWVEF and the Kaiser Family Foundation undertook a major citizen education effort, "Citizen's Voice for Citizen's Choice: A Campaign for a Public Voice on Health Care Reform." The project delivered objective information on health care reform to millions of Americans across the country. Local and state Leagues sponsored more than 60 town meetings in major media markets nationwide, involving members of Congress and other leading policy makers and analysts in health care discussions with citizens. In September 1994, the LWVEF and the Kaiser Family Foundation held a National Satellite Town Meeting on Health Care Reform, with more than 200 downlink sites across the country. The two organizations also undertook a major television advertising effort to promote public participation in the health care debate.
Underlined areas indicate a change or addition.
( Bracketed and underlined) indicate removal.