By Lily Jung, MD, FAAN
According to a recent Kaiser Family Foundation poll, American voters ranked health care as the third most important issue in the upcoming presidential campaign. In a San Francisco Chronicle survey in March, 95% of 26,000 people surveyed agreed that health care in the United States needs to be fundamentally changed.
Along those lines, the National Multiple Sclerosis Society has adopted seven key principles related to national health care reform. Taken at the Society's recent 17th Annual MS Public Policy Conference in Washington, DC, this decision was the result of action by the newly created Federal Activism Council, which developed a subcommittee composed of MS patients, volunteers, staff, and neurologists to advocate for improved healthcare for MS patients. Although the Federal Activism Council identified several issues that were of concern to MS patients, the fundamental construct of the health care system in the United States was felt to be the cornerstone upon which expectations of health care provision should be based.
The seven key principles of national health care reform adopted by the National Multiple Sclerosis Society are summarized below.
Access should be assured regardless of health or disability, employment status, age, claims history or risk, with renewable and portable coverage and elimination of waiting periods and pre-existing condition exclusion periods. Elimination of the 24-month waiting period for Medicare coverage upon qualifying for Social Security Disability Insurance benefits should be a requirement, and a basic minimum and comprehensive benefit package should be standardized to achieve optimal health.
Premiums should reflect a broad distribution of risk and not disadvantage people due to poor health status or claims experience. Out-of-pocket costs including deductibles, co-pays, and co-insurance amounts should be limited to prevent financial devastation to those most in need of care. Provisions to support those who are most financially needy should be in place. Such provisions should include annual caps on medical expenses, stop-loss provisions, sliding scales, negotiated payments, and the elimination of lifetime maximums on benefits. Standardization of reasonable medical loss ratios of health plans should occur.
Reimbursement should help reward and promote positive outcomes, including therapies that help prevent physical and cognitive deterioration. All health plans should provide for timely and independent appeals including clear guidance to patients and providers on how to pursue them.
To assure people with physical disabilities have the same access to health care as others, accessible equipment and exam tables, and assistive technology and appropriate assistance when needed should be available in all health care settings. Accessible transportation to needed providers and services, including appropriate specialist care, should be available, regardless of whether the individual lives in an urban, rural, or suburban setting.
Health care services for individuals with chronic illnesses should include access to the full spectrum of health care needed across the person’s lifetime, including medical care, prescription drugs, dental care, rehabilitation services, preventive care, hospital in-patient care, and durable medical equipment. Provider reimbursement rates should be increased to reflect the complex care required to treat those with chronic illnesses, helping to ensure an adequate number of providers is available.
Medical records should be standardized system-wide, allowing for patient-controlled access to records and strict privacy standards and safeguards. Systems to reduce unnecessary or duplicative procedures and treatments should be implemented. Waste, fraud, and abuse should be targeted and systematically reduced.
The Olmstead principle provides the basis for accessible home and community-based care support to allow people to be as independent as possible in the most appropriate integrated setting. The importance of the role of the caregiver should be included in the design of adequate supports, including fair pay and adequate training.
These principles, although created with MS and other chronic illnesses in mind, could potentially serve as a basis for a broader national health care reform platform. While not all professional groups have adopted policies regarding reforms, groups such as the American College of Physicians and the American Academy of Family Medicine have taken a stance by advocating for much needed changes in the health care field not dissimilar to those espoused by the Society. The American Academy of Neurology could learn from these other organizations and adopt a comprehensive platform for health care reform. Given the vulnerable communities that neurologists serve—including patients with lifelong disabling conditions—it seems appropriate for neurologists to take a leading role in advocating for much needed changes in the health care system, changes that would allow for more efficient and equitable delivery of care for our patients.