Health policy experts disagree about how to expand access to health coverage, but many agree that the federal government should ensure that all Americans have coverage for “basic and essential health care services.”

Researchers at the U.S. Government Accountability Office have presented that finding in a review of a recent GAO forum on the future of the U.S. health care system.

The GAO polled the 29 forum participants to get their opinions about how the federal government and state governments might improve health care and health finance.

The 29 participants included Charles Kahn, a former president of the old Health Insurance Association of America, Washington, who now leads a hospital trade group, and Karen Ignagni, president of America’s Health Insurance Plans, Washington.

The participant list also included representatives from consumer groups, Democratic think tanks, and analytical organizations, such as the Employee Benefit Research Institute, Washington.

The GAO found no agreement among forum participants about whether states or the federal government should “take the lead in expanding access to health insurance to all residents” or whether “the United States should continue to rely on employer-sponsored health care coverage as the backbone of the U.S. system of coverage,” according to the GAO staffers who wrote the forum report.

But the GAO found that many of the participants agreed that “the federal government should assure that a health insurance market exists that adequately pools risk and offers alternative levels of coverage.”

The GAO found strong agreement for the idea that “the federal government should ensure that all Americans are covered for basic and essential health care services.”

Only 1 of the participants was neutral about the idea of the federal government ensuring that all Americans have coverage for basic health care services, and all of the others said they agree or strongly agree with that principle.

The GAO also found strong support for the idea that the federal government should take the lead in developing indicators for measuring the performance of the U.S. health care system.

David Walker, comptroller general of the United States and head of the GAO, put his own plea for action in the preface to the forum report.

“I live each day with the knowledge and certainty that unless we fix our health care system–in both the public and private sectors–rising health care costs will have severe, adverse consequences for the federal budget as well as the U.S. economy in the not too distant future,” Walker writes in the preface.

“Our longer-range federal fiscal outlook, owing significantly to federal health care entitlement spending, remains grim; Medicare and Medicaid spending threaten to consume an untenable share of the national economy in the coming decades,” Walker warns. “Health care spending systemwide continues to grow at an unsustainable pace, eroding the ability of employers to provide coverage to their workers and undercutting our competitive advantage.

“Finally, despite spending far more of our economy on health care than other nations, the United States has above average infant mortality, below average life expectancy, and the largest percentage of uninsured individuals. … Time is relatively short before budgetary pressures end the chance for health experts to decide deliberatively and thoughtfully on the future of the nation’s health care system.”

Walker says he hopes the American people will take an interest in the topic in time to save the country’s fiscal future.

A copy of the GAO report is on the Web