AFT Resolution

THE FUTURE OF HEALTH CARE

WHEREAS, union members have historically enjoyed comprehensive health coverage requiring little or no personal financial contribution, but spiraling health care costs have resulted in efforts by employers to shift costs to employees through higher deductibles, co-payments and diminished coverage; and

WHEREAS, efforts by the federal government to control health care costs have restricted hospital admissions to acutely ill individuals and significantly shortened hospital stays; and

WHEREAS, a severe shortage of health professionals affects their ability to deliver the quality of care patients deserve and ultimately affects the health and well-being of society as a whole, the leadership of FNHP requested that the AFT executive council appoint a Task Force on the Future of Health Care to analyze current conditions, explore proposals and make recommendations; and

WHEREAS, the Task Force formed in July 1988 conducted an extensive investigation through presentations by policy experts who focused on the issues of cost, access and quality.

The Task Force found that:

Health care costs in the U.S. have risen from 7.2 percent of the gross national product in 1972 to 11.2 percent in 1987. On the other hand, countries with nationalized health care have been far more successful in controlling their health care costs. For example, in 1970, Canada finalized implementation of its national health care system. Their costs rose from 7.2 percent in 1970 to 8.6 percent in 1987. Other industrialized nations like Japan, France, Germany and Great Britain have kept costs in the range of 6.1 to 8.6 percent also. Health care spending in the U.S. has become disproportionate to the percentage of spending for both education and defense, which has, in fact, dropped from 1970 to 1987.

Increased spending on health care has not brought coverage to more citizens. Some 30 million to 37 million Americans are uninsured, and over 50 million are underinsured and would be made bankrupt by catastrophic illness. Of those uninsured, approximately two-thirds are employed or dependent on someone who is but have no coverage through their job. One in five is a child.

Federal provisions for the poor and elderly, Medicaid and Medicare, have been less than adequate. Bureaucratic processes make application for Medicaid difficult, and stringent rules have left the "working poor" unable to qualify for health coverage. In addition, nearly 46 percent of Medicaid dollars are now being spent to finance long-term care. Seniors spend 18.2 percent of their income to compensate for what Medicare does not cover.

Geographic maldistribution of health care facilities and health professionals is significant in many rural and some urban areas and impedes access to care for those residing there. In addition, cultural differences and language barriers also result in access problems.

Although the U.S. spends more than any other nation on health care, many question the quality of care purchased for the health care dollar. Infant mortality in the U.S. is higher than in any other industrialized nation.

American medical care also lacks standard treatment protocols. Medical practices vary from physician to physician and state to state. Data are now being collected to help define the practices that yield the best results and also monitor the cost effectiveness of various treatments. Early information shows that high cost is almost always an indicator of inappropriate or excessive treatment. Shortages of health professionals have forced hospitals to close beds or use personnel inadequately trained to deliver care.

National surveys show that Americans strongly support sweeping reform. This conclusion has also been reached by the Task Force on the Future of Health Care, and the resolves that follow comprise statements of principles and strategies believed to define cost-effective, high-quality health care for all Americans:

RESOLVED, that the AFT endorse reform of the health care system that encompasses the following principles: Health care cost containment is a priority and should be accomplished by:

establishing a single payment system for all basic services to prevent cost shifting and reduce administrative expenditures;

setting national caps on health care spending;

monitoring and eliminating duplicative or unnecessary services and technologies on a national, state or local level;

establishing a national data bank to collect and disseminate information on health care costs and quality and on the cost effectiveness of treatments and medications;

encouraging and reimbursing preventive care;

providing incentives that reward health care providers and health care systems that demonstrate they can deliver high-quality, cost-effective care;

establishing state coordinating bodies comprising consumers, unions, businesses, ethicists, providers and government to create and monitor incentive programs and quality indices and coordinate capital investment and expenditures based on community needs;

focusing resources on health promotion, health education and disease prevention to reduce illness, high-risk behavior and unnecessary institutionalization; and

supporting safe and healthy workplaces and strategies for environmental protection and cleanup.

Uniform high-quality health care services are vital and should be accomplished by:

recruiting adequate numbers of health professionals to maintain the ability to deliver high-quality care;

collecting and publicly disseminating data on treatment outcomes, by facility and by practitioner, and consumer attitudes about their quality of life after medical treatment;

establishing standards of medical practice and clinical guidelines to be used as a basis for high-quality health care and as a means to reduce the incidence of malpractice;

promoting systems of managed care and case management that monitor and coordinate care of individuals to reduce fragmentation of services, ensure access and control costs;

preserving consumer freedom of choice of providers and setting of care; and

promoting health education as an integral part of any treatment or intervention, as a means to foster appropriate behavior that prevent or reduce illness and provision of health education should be encouraged in community settings, through the media, in the schools and workplaces.

Individuals should have universal access to a basic national standard of high-quality care including preventive, acute, prenatal, mental health, long-term and rehabilitative care and drug therapies prescribed as part of the treatment. Such access should be fostered by:

eliminating financial barriers to care;

promoting expansion of existing community-based health centers and development of new centers for use by all consumers;

promoting utilization of nurses and other health professionals as primary providers;

ensuring portability of health care coverage and providing protection when moving between jobs or states;

providing financial incentives such as loan forgiveness or free education to ensure adequate supply of health professionals especially in underserved or shortage areas;

encouraging health systems that improve access through flexible hours and by providing both transportation and child care services;

supporting mobile clinics and school and workplace clinics;

providing translation services in any health care setting where English is not the primary language and providing cultural awareness training for health professionals;

providing broad based programs to pay for long-term care that will not require spending down of personal assets;

supporting home and community based alternatives to institutional long term care available to all ages;

supporting long term care eligibility requirements other than individual inability to perform three legislatively defined activities of daily living;

providing training, support and respite care for family members and others participating in home care; and

supporting health care systems that demonstrate high retention and job satisfaction rates for health professionals and health care workers; and

RESOLVED, that the AFT prepare educational material for members regarding problems with the health care system and the need for national reform; and

RESOLVED, that AFT update its material on negotiating health care benefits and cost containment; and

RESOLVED, that AFT research the impact on the education system of skyrocketing health care costs and declining health status of children; and

RESOLVED, that AFT continue its support of the AFL-CIO strategies for national health reform; and

RESOLVED, that AFT develop its own grassroots campaign to educate and involve members in change; and

RESOLVED, that AFT research the impact of the severe nursing and allied health professional shortage on the quality of health care services; and

RESOLVED, that AFT create a committee on health care reform comprising representatives from all AFT divisions to provide guidance on methods to reduce health care costs and reform the health care system.

[This resolution incorporates a summary of the findings, along with the complete recommendations, of the Task Force. The entire Task Force report was adopted by the council as a resolution at its April 1990 meeting.]

(1990)