The Institute for Health Policy Solutions is committed to finding ways to create a health system that is fair and feasible and involves coverage by and for all^SM Americans - one in which all Americans have health coverage, and the responsibility for financial participation within their means.

Many failed campaigns to cover the uninsured have focused only on the need to cover vulnerable uninsured populations and on the risk others face of becoming uninsured. Because major coverage reform proposals were often portrayed as universally painless, they were successfuly discredited by opponents who highlighted the increased burdens some would bear. Thus, the failure to clarify the individual and mutual responsibilities necessary to a fair and feasible coverage system has been ultimately self-defeating.

These and other basic economic realities cannot be wished or pretended away if we are to achieve coverage and access to care for all Americans. For example, it must be recognized that poor populations cannot afford access to needed care if they are required to contribute beyond their means. Providers are not in a position to finance care for growing numbers of un- and under-insured persons through cost shifts to already over-burdened employers who cover their own workers and dependents.

It is also counter-productive to hold the uninsured problem hostage to the growing health care cost crisis. Cost accountability is an elemental prerequisite to cost discipline. We cannot achieve cost accountability until and unless we replace our Byzantine labyrinth of cross-subsidies for the uninsured with direct coverage.

Incremental approaches that do not move towards essential individual and mutual responsibilities have not solved the fundamental problems of our health care system, and cannot do so. These approaches fail in part because they do not recognize a fundamental relationship: We cannot guarantee everyone access to medical care when needed unless everyone participates in the health coverage system that finances such access. Incremental approaches to date have too often done more to shift where people get coverage than to reduce the number of uninsured.

Until we move towards a system that not only assures access to affordable coverage, but also expects participation by all, the uninsured population and the financial stresses on the system will only continue to grow. The Institute for Health Policy Solutions intends to be a resource for change that achieves such access and participation.