Family-practice doctors seek to reawaken US health-care debate

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I an attempt to rekindle the US health-care debate, the American Academy of Family Physicians (AAFP) has released an outline of a health-care reform plan that would provide basic and highexpense catastrophic health-care services to everyone living within US borders. The basic programme will be funded by a payroll tax. The academy has sent copies of the plan to more than 200 US organisations, including professional medical societies, labour unions, and consumer and business groups, inviting comment. In addition, the proposal has been posted on the AAFP’s web site so that it can be reviewed and commented on by the general public. (http://www. aafp.org/unicov/) AAFP’s President, Richard Roberts said the Academy’s initiative was necessary because US political leaders have given up on health-care reform since President Bill Clinton’s healthreform initiative collapsed in 1993—a debacle that many blame for his party’s drubbing in the 1994 elections. In the meantime, the US health-care system has continued to deteriorate, Roberts said. “Since 1993 the number of uninsured has risen from 33 million to 42 million today, despite the most robust economy anyone can remember, and the number of under-insured is probably 25–30 million—so you have 1 in 4 Americans without adequate or any insurance”. AAFP’s plan tries to provide for the collective needs of society without violating the US ethic of individualism, Roberts said. Under the proposed system, everyone living in the USA, whether or not they were legal residents, would have access to basic health care, which would include care for all common medical conditions. Coverage would be limited to interventions that are “evidence-based, high-quality, and cost-efficient”. In the case of a major illness, out-of-pocket expenditures not covered by the basic plan would be capped at US$5000 per individual and $8000 per family, with an additional 20% co-payment, up to a total expenditure of $10 000. People wanting services not covered under the basic plan would be free to purchase additional coverage on their own or employers might offer such coverage as part of a benefit package. This would give individuals a great deal of freedom of choice, said Roberts. The AAFP estimates that the system will add about US$ 45 billion a year to the US health-care budget, a mere 5% increase. The AAFP Board of Directors will now review comments before drawing up a detailed plan for presentation to the AAFP’s Congress of Delegates in October.