As the presidential race heats up, momentum is building for organizations trying to generate consensus that a new healthcare insurance system is a critical issue in the U.S.

A coalition of 100 such groups, Health Care for America Now (HCAN: Washington), has just emerged and is demanding that the first order of business of the next president and Congress is to enact quality, affordable healthcare for all in 2009.

"Our group's goal is to establish a healthcare insurance system that has coverage for all, has got good benefits, doesn't discriminate against the sick and is affordable to businesses and individuals," Richard Kirsch, national campaign manager for HCAN, told Medical Device Daily. "Cost of the insurance would be relative to people's income. Right now, cost of coverage has nothing to do with what you make. Someone who makes $200,000 pays the same costs for insurance as someone who makes $20,000."

HCAN is a coalition led by Washington-based action groups such as the Association of Community Organizations for Reform Now; American Federation of State, County and Municipal Employees; Americans United for Change; Campaign for America's Future; Center for American Progress Action Fund; Center for Community Change; MoveOn.org; National Education Association; National Women's Law Center; Planned Parenthood Federation of America; Service Employees International Union; United Food and Commercial Workers; and USAction.

"It's pretty clear the country is so ready for this," Kirsch said. "Polls show that two-thirds of Americans support healthcare for all, even if it means more taxes. It's a top issue next to the economy. The economic pressures of healthcare are a continuing burden. The fact that you have Barack Obama saying he's coming up with a plan in the first 100 days and John McCain's first initiative is also around healthcare shows that the next president knows this is an important issue."

HCAN's proposal would involve allowing people to pay for insurance on a sliding scale, relative to income level. But Kirsch's group isn't tied to either candidate's proposal and is not proposing a specific funding strategy to back insurance for all.

"If there's a shortfall it should be paid for by the public," he said. "One way to do it is to say that employers would have a choice to pay a percentage of their payroll for coverage, like a payroll tax for employers if they decide to provide private coverage."

Kirsch said his group wants to see a system where insurance companies compete around quality. "And, we need to invest in prevention and chronic care management," he said.

To the makers of devices and other healthcare products, "There's no evidence that this will impact their financial structure and there's no reason incentives for research would decrease. In fact, there should be incentives for research for people to get the best healthcare."

HCAN is seeking to change healthcare insurance in the U.S. so that it is:

• An inclusive and accessible healthcare system in which no one is left out.

• A choice of a private insurance plan and a public insurance plan for those who need it without a private insurer middleman that guarantees affordable coverage.

• A standard for health benefits that covers what people need to keep healthy and to be treated when they are ill.

• Healthcare coverage with out-of-pocket costs including premiums, co-pays and deductibles that are based on a family's ability to pay.

• Equity in healthcare access, treatment, research and resources to people and communities of color, resulting in the elimination of racial disparities.

• Health coverage through the largest possible pools in order to achieve affordable, quality coverage for the entire population and to share risk fairly.

• A watchdog role on all plans, to assure that risk is fairly spread among all payers and that insurers do not turn people away, raise rates or drop coverage based on a person's health history or wrongly delay or deny care.

• A choice of doctors, health providers and public and private plans, without gaps in coverage or access.

• Affordable and predictable health costs to businesses and employers.

• Effective cost controls that promote quality, lower administrative costs and long term financial sustainability.

Following a series of local rallies last week in major cities across the country, the campaign is spending an initial $1.5 million on national television, print and online advertising and is sending out an e-mail blast to more than 5 million people. Over the next five months, HCAN plans to spend $25 million in paid media, with 100 organizers in 45 states asking members of Congress, "Which side are you on?"

A few weeks ago, Physicians for a National Health Program (PNHP; Chicago) joined forces in support of a bill in Congress, H.R. 676, which embodies a single-payer approach that mimics Medicare (MDD, June 24, 2008).

Although Kirsch said his group does not support a single-payer system or H.R. 676, "We're not saying you have to have one particular solution. We need to regulate the existing private insurance industry so they can't discriminate against people and then we need to have an option to have a public health insurance plan for those who need it. We support approaches that meet those goals."