One aspect of health care reform is having a devastating impact on all the others: the rising costs of care. While reducing the number of uninsured and improving health care quality are critical goals, unless we can find ways to reduce rising costs, universal coverage may simply be unattainable.

Addressing this problem makes many people uncomfortable -- consumers, policymakers and providers alike. It is difficult to reduce costs without challenging many of the expectations and assumptions we all have about choice, treatment options and delivery systems. When it comes to rising costs, there are no easy answers and there are no "right" answers.

Eight years ago, SHD began engaging the public in the options and dilemmas we face in seeking responsible ways to allocate our shared resources. SHD's interest stems from four key points:

• This subject receives too little attention in the health care debates.
• Decisions require careful consideration of personal and societal priorities.
• Tackling health care costs requires individuals to think as citizens, not just as patients or providers.
• Policymakers need to understand the views of an informed public.

 Current programs:

What Matters Most: Consumers distinguish essential from non-essential coverage.
Working with Other States: Consultation to help states identify coverage priorities.
CHAT Sessions: Healthcare/business leaders wrestle with trade-offs.

 Previous Projects:

Just Coverage:The public explores basic health coverage.
Getting Good Value:Citizens grapple with the high cost of medical treatments.
Medi-Cal CHAT:Disabled adults prioritize their Medi-Cal benefits.
Capitol Region CHAT:Employees consider trade-offs in healthcare benefits.
Visible Fairness:The public debates cost-effectiveness in coverage decisions.

 Noteworthy:

New America Foundation commissions SHD policy paper on benefits design

In the forefront of promoting a bipartisan approach to universal coverage, NAF′s Health Policy director Len Nichols is an enthusiastic supporter of SHD′s work. At his request, Executive Director Marge Ginsburg prepared a detailed look at strategies for developing a sustainable healthcare benefits package. With a strong emphasis on citizen participation, Balancing Act: Creating a Sustainable Health Care Benefits Package examines the types of trade-offs that policymakers and the public must consider.

When the paper was released in Nov, 2007, Ginsburg was the featured speaker for a policy briefing in Washington DC arranged by NAF. More than 60 capitol hill staff and healthcare policy leaders attended her presentation, Health Insurance: What Should Everyone Be Covered For? CSPAN3 provided live coverage of the event.