HEALTH INSURANCE FOR ALL

We are pleased to present A Roadmap to Health Insurance for All: Principles for Reform, authored by
The Commonwealth Fund’s Sara Collins and colleagues, and endorsed by The Commonwealth
Fund Commission on A High Performance Health System. In August 2006, the Commission, in
its first publication, Framework for a High Performance Health System for the United States, identified
access to care as the cornerstone of a high performance health system. The Commission defined
the components of access to include: universal participation; a minimum level of financial
protection and established benefits for all; affordable care; and equitable care. In a subsequent
report, which presented findings from a scorecard of health system performance by state, the
Commission found that quality of care is directly related to access to care.
Since the Commission began its work more than two years ago, Americans have begun to realize
that U.S. health care system performance is not as good as it could be. Despite spending more on
health care than any other country in the world, our system could be more effective, efficient, and
equitable, and could enable us to lead longer, healthier, and more productive lives. Many health care
reform plans begin with a proposal for expansion of health insurance coverage. The need for such
coverage expansion is considered an essential component for many of these plans. A Roadmap to
Health Insurance for All makes a compelling case that, unless there is coverage for everyone, the
United States cannot have a high performance health system associated with more effective and
efficient care and longer, healthier, and more productive lives. If our society is to continue to prosper,
we must ensure coverage for all Americans. Yet, the report makes clear that the reform strategies
will have an impact both on coverage and on the prospects for improving quality and efficiency.
The Roadmap presents a set of principles endorsed by the Commission that Americans can use to
evaluate proposals for health insurance reform. It frames the evaluation of these proposals around
three different approaches: tax incentives and individual insurance market; mixed private–public
group insurance with shared responsibility for financing; and public insurance. The Commission
believes that the most pragmatic approach to coverage for all is mixed private–public group
insurance, an approach that builds on our current system of health insurance with shared responsibility
for financing from individuals, employers, and government that minimizes dislocation for the
millions of Americans who currently have good coverage. The Commission also believes that
reforms to improve quality and efficiency should be pursued at the same time as reforms that
provide coverage expansion. In November 2007, we will issue recommendations for moving
forward in these areas, with future reports providing specific policy guidance to achieve a high
performance health system. It is our hope that these reports will help national and state leaders
grappling with these difficult issues and contribute to informed debate and discussion about the
future direction of the U.S. health system.
joining the Fund, she was vice president of AcademyHealth where she served as program
director for the Robert Wood Johnson Foundation’s Changes in Health Care Financing
and Organization initiative; senior advisor for the Foundation’s State Coverage Initiative;
and a co-project director for a Fund project on administrative simplification in health care.
Before joining AcademyHealth in 1989, she was senior researcher for the National
Leadership Commission on Health Care. She held a position in the congressional Office
of Technology Assessment from 1980 to 1986. Ms. Gauthier holds an A.B. in molecular
biology from Princeton University and an M.S. in health administration from the
University of Massachusetts School of Public Health.