These are Change to Win’s principles for creating an American health care system built on our nation’s values:

1. Guaranteed Coverage: Everyone should have access to quality affordable health care.
• Coverage should be portable and not discriminate against people based on preexisting medical conditions, health status, age, race or ethnicity.
2. Guaranteed Benefits: A standard health care benefit should meet people’s medical needs.
• Benefits should provide access to all medically necessary care.
• The system should be reoriented from one focused on sick care to one focused on preventive care and better management of care provided to the chronically ill to promote health and control costs.
3. Fair Financing: The health care system should be broadly and fairly financed.
• Financing should not place an undue burden on individuals.
• Federal, state and local governments are major payers of health insurance and services for the elderly, people with disabilities and the poor; their significant contributions must be preserved and expanded where necessary to finance the system.
• The system should also be financed in ways that spread risks as broadly as possible, reduce costs, and promote efficiency and fairness.
• Health care financing should ensure a level playing field between employers in the global marketplace. Responsible U.S. employers that provide coverage for their workers should not bear the burden of covering health care costs of the uninsured and under-insured. The ability of some employers to free-ride on the system at the expense of their competitors must not continue.
• The health care system should allow unions to negotiate with employers for supplemental benefits to the standard health care benefit.
4. Strong Cost Controls: Our health care system should be efficient, reduce waste and curb excessive profits.
• To ensure quality, cost effectiveness and accountability, data on hospital and physician quality, outcomes, utilization and prices must be made widely available.
• To significantly reduce administrative costs, insurance bureaucracy needs to be pared back with simple, clear rules that doctors and patients can understand.
• Public insurance plans should have full authority to negotiate the prices they pay for health care services, including payments to private health plans, health care providers and prescription drug companies.
5. Choice of Provider: Everyone should have a choice of doctors and other health care providers.
• People should be educated, informed and responsible for choosing the doctors and other health care providers who will take care of them.
• The delivery system must meet the special needs of at-risk populations and eliminate economic and racial disparities in health care and health status.
6. Quality of Care: Substantial investments are needed to improve patient safety and health care outcomes and to control costs.
• Major improvements should be made to the quality of care to reduce medical errors and avoid unnecessary hospitalizations, thereby reducing costs.
• The federal government should expand and accelerate the use of public programs for advancing strategies that improve quality and efficiency across the health care system, such as evidence-based best practices and health information technologies and electronic record systems.
7. Role of Government: Government should be the watchdog and the enforcer of rules, and it should efficiently manage public insurance plans.
• Given the powerful interest groups with a financial stake in health care, the government should serve as a watchdog and enforcer of rules to ensure fairness, access and that the patient’s health comes first.
• The government must ensure strong and efficiently managed public insurance that provides coverage to veterans, seniors, people with disabilities, the poor, people of low-income and to others at least already now covered.
8. Privatized High-Deductible Health Plans Are Not the Answer: A comprehensive solution to our health care crisis is required.
• Patients should take personal responsibility for their health, but that should not mean shifting the burden of financing health care onto individuals and families through privatized high-deductible health plans and Health Savings Accounts.
• Such plans do the opposite of the type of reform our system needs by limiting preventive care, failing to address high-cost patients who account for most health spending and providing large tax breaks to those who least need assistance.

While senior citizens, people with disabilities and many of the poor are covered by the public insurance programs of Medicare and Medicaid, most Americans have depended on employers to provide them with health insurance. Labor unions played the leading role in creating our employer-based health care system through collective bargaining.  Health insurance fully paid by the employer was a marker that defined good jobs in the U.S. economy. As a result of labor’s success, the vast majority of workers – union and non-union – received health care coverage on the job.

This achievement was a hallmark of the American Dream, but it is unraveling in the face of dramatic economic changes. Costs are exploding, coverage is eroding and quality is deteriorating. The fragmentation of our health care system, insurance company bureaucracy and overhead prevents us from spending our health care dollars wisely and most effectively. Nearly 47 million among us are uninsured, and millions more are underinsured. Hundreds of thousands of preventable medical errors, injuries and deaths annually contribute to escalating costs.

Skyrocketing costs are now the most pressing threat to American families, our communities, and the ability for U.S. businesses to compete in the 21st century. Employers are reducing or eliminating health benefits and shifting more of the burden to workers. Every major union contract negotiation in recent years has been defined by union struggles to protect the health care security of workers.

Change to Win believes we need a public-private partnership of unions and employers along with elected officials, health care providers and consumers to solve the crisis. Unions played a leading role in supporting and expanding the employer-based system and will be a key element in reforming the system to meet the realities of today’s economy. Millions of union members bring market power, innovation, expertise and leadership to ensure the viability of the U.S. health care system and the health of workers in America.