A Word from Christine Ferguson, J.D.

Christine Ferguson is an associate research professor in the department of Health Policy at The George Washington University. She co-authored a Covering America paper, "Medicaid: What Any Serious Health Reform Proposal Needs to Consider."

How our health care system succeeds or fails fundamentally affects each of us. No leader in either the public or private sector can afford to avoid this problem any longer. Large and small businesses, government at every level, as well as their employees and retirees, are facing the crush of health care costs and the threat of losing both the quality of life and the coverage they expect. The new Administration has rightly focused attention on the importance of reducing the growth of spending in health care, making both its availability and cost more predictable and manageable.

Those of us who have been involved in this debate for several decades understand the difficulty and complexity of the task our new President and leaders in Congress have undertaken, but most of us also agree that we cannot afford to fail again. Since the last debate, accounting standards have created more and more transparency in both the funded and unfunded commitments of the public and private sectors. Mayors and town councils, publicly traded companies as well as the federal government are struggling to come up with strategies to cope with the anticipated tsunami of retirees who have been promised health care coverage for the rest of their lives even as these health care purchasers are experiencing mammoth losses in revenue and an uncertain economic future.

In addition, the 85 percent of Americans who actually have insurance coverage may be feeling, for the first time, a real vulnerability—and they would be right. The IOM recently released a report called "America's Uninsured Crisis: Consequences for Health and Health Care," which talks about both the possibility of continued erosion of coverage and the "spill-over effect" of rates of high uninsurance in a community on those who have coverage: reduced access, satisfaction and quality of care.

Having such high stakes simply increases the intensity of the debate in which we will be engaged in the next year. In the past, acrimonious and pitched battles often meant that substantive discussions over the range of possible reform options, and the components that would be necessary for any of them to succeed, were lost in the scuffle.

The Covering America project is an attempt by RWJF and ESRI to avoid this problem in the upcoming debate. All of those involved agreed to participate with a desire to produce the best range of options for consideration by leaders at the national level when the inevitable "new" health reform debate began. They designed Covering America before the atmosphere became too politically charged, to provide an opportunity for a robust discussion of a broad range of proposals spanning the ideological spectrum with commentators and advisors from an equally impressive range of experience and viewpoints.

The project represents a unique opportunity for today's policy-makers to look at a full range of very well developed health reform and coverage options that encompass most philosophical ideas. Each proposal was developed through a process that included honest critiques guided by a sincere desire by all involved to ensure that the final product was the strongest it could possibly be, regardless of the political views of the reviewers. Thus, the proposals that are contained in Covering America are the product of a real bipartisan effort to ensure each as drafted could actually be effectively implemented.

As someone who has served at both the federal and state levels of government, I was more convinced than ever through this process that if America can simply pick a direction and move forward, those of us who are passionate about coverage, access and cost control can make virtually anything work—even if it is not our desired approach.

No one should believe that inaction will maintain the status quo in our health care system. The system is changing and evolving even as I write this and will continue to do so even if the Congress cannot agree on a direction. Those of us who have worked in the trenches in our health care system understand this and have seen firsthand the damage caused by the lack of clarity and common sense. The erosion of care, quality and coverage will continue, as will the growth in the cost to individuals, taxpayers, consumers and business. The only thing the status quo can guarantee is that few, if any of us, will have a say in the direction our health care system takes next, and that this lack of thoughtful and deliberate decision making will lead to a system that will continue to eat up larger and larger portions of our collective resources while not improving the health outcomes of our citizens.

It is time to act. We hope this guide will help those who are serious about progress move forward with deliberate speed and determination.