Chapter[ Detailed Plan
Section[ Promoting Shared Responsibility
Promoting Shared Responsibility
One cause of the crisis in the health care system is that rather than containing costs, the system shifts
them: about half of all hospital losses are passed along to other payers.v Rather than reducing prices,
the system raises families’ costs. In fact, people in high-deductible plans are twice as likely to delay or
avoid needed care due to costs.vi Rather than rewarding health, the system pays more for acute
treatment than prevention, and gives individuals no direct incentives to promote their own health.
And, rather than covering all Americans, the system charges insured families a “hidden tax”: premiums
are roughly $900 higher to pay for the cost of care for the uninsured.vii Hillary Clinton’s American Health
Choices Plan is based on the principle of shared responsibility. This plan ensures that all who benefit from the system contribute to its financing and management. Specifically, responsibilities include:
• Insurance and Drug Companies: For insurers, to end discrimination based on pre-existing
conditions or expectations of illness and ensure high value for every premium dollar; and
for drug companies, to offer fair prices and accurate information;
• Individuals: To get and keep insurance in a system where insurance is affordable and
accessible;
• Providers: To work collaboratively to provide high-quality care;
• Employers: To contribute to health coverage, with large firms required to provide health
insurance or contribute to the cost of the system, and small businesses offered tax
incentives to continue or begin to offer coverage;
• Government: To ensure that health insurance is always affordable through investments in
tax credits and the safety net so that coverage is never again a crushing financial burden;
to improve the quality performance of the system; and to end the upward cost spiral of the
system that threatens our health and economy.
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iv. J.M. McGinnis. (May 5, 2007). “The Evidence Imperative,” Presentation on behalf of the Institute of Medicine Roundtable on Evidence-Based Medicine.
v. D. Dranove. (March 1998). “Pricing by Non-Profit Institutions: The Case of Cost Shifting in Hospitals,” Journal of Health Economics, 7(1); F. Sloan and E.
Becker. (Winter 1984). “Cross-Subsidies and Payments for Hospital Care,” Journal of Health Politics, Policy and Law, 8(4).
vi. P. Fronstin and S. R. Collins. (December 2006). The 2nd Annual EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2006: Early Experience
With High-Deductible and Consumer-Driven Health Plans. New York: The Commonwealth Fund.
vii. Families USA. (July 13, 2005). Paying a Premium: The Increased Cost of Care for the Uninsured. Washington, DC: Families USA.
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