Report Urges U.S. to Work On Better Health Coverage

Because the growing number of Americans without health insurance results in unnecessary sickness and death, weakens the nation’s economy and undermines the entire health care system, the federal government must begin working now to expand coverage to all Americans by 2010, the Institute of Medicine said Wednesday.

The nonpartisan organization, which advises the government on health issues, declined to endorse a specific strategy for health care reform. But its new report, “Insuring America’s Health: Principles and Recommendations,” called on President Bush, Congress and the Democratic presidential contenders to reject piecemeal proposals.

After three years of intensive research and five previous reports on the costs of insurance, the institute concluded that “small steps are inadequate,” said Mary Sue Coleman, president of the University of Michigan and co-chair of the committee that wrote the report. “It is time to insure America’s health.”

The Democratic candidates have released proposals that range from incremental expansions of Medicaid, the government’s health care program for the poor, to national health insurance. And Bush is expected next week to renew his call for tax credits to help those without health insurance purchase it.

Earlier this week, the administration dismissed calls for universal coverage.

“It’s not realistic,” Health and Human Services Secretary Tommy G. Thompson told reporters. “I don’t think, administratively or legislatively, it’s feasible.”

More than 43 million Americans had no health insurance at any time in 2002, according to the Census Bureau. That year’s increase in the share of uninsured Americans, from 14.6% in 2001 to 15.2%, was the largest in a decade.

Calling 43 million “a big, big number,” former Sen. Bob Dole, the Republican presidential candidate in 1996, strongly endorsed the institute’s report.

Dole called on lawmakers from both parties to cooperate on the issue and encouraged voters to demand specific coverage plans from both Bush and the Democratic presidential nominee.

In spite of “the scope of the problem and the [limited resources] of our federal government,” Dole said, “I think we have what it takes to get it done. All we lack is the will to get it done.”

“There are two major obstacles,” said Dr. Arthur L. Kellermann, co-chair of the institute’s committee and head of emergency medicine at Emory University. “First is the knee-jerk response that we can’t afford” universal health coverage.

The second, he said, is the “it’s my plan or the status quo” approach of many politicians.

Presidents and lawmakers have debated the costs and benefits of universal health coverage since 1939, and health insurance plans have been proposed and killed in virtually every Congress since President Clinton’s health reform plan went down in flames 10 years ago.

Since establishing Medicare and Medicaid in 1965, Congress has significantly expanded health coverage only once, with the 1997 creation of the state-federal Children’s Health Insurance Program.

The institute’s latest report, like the previous five, tried to sidestep the politics of how to expand health-care coverage. Instead, it offered five principles it said should be used to evaluate health reform proposals.

Acceptable strategies would provide health care that is available to all, continuous, and affordable for individuals, families and society. In addition, the report said, a good health-care program would include measures to control costs and improve quality.

Using those guidelines, the committee graded four generic health insurance strategies. It compared a single-payer plan, which would provide coverage through one standard benefit plan financed by the government, with a program that would expand Medicare and Medicaid and offer tax credits, a proposal that would require employers to offer coverage or pay into a government program, and a plan that would offer tax credits but require individuals and families to buy coverage.

The committee concluded that the single-payer plan was likely to achieve universal and continuous coverage. But the costs of such a plan would be high, it noted.

Each of the other plans would cost less but would only reduce, not eliminate, the number of Americans without insurance.

While each reform plan had its strengths and weaknesses, the committee concluded that the current health-care system met none of its guidelines.

The Centers for Medicare and Medicaid Services reported last week that the nation’s health-care spending increased 9.3% in 2002, to a total of $1.55 billion. That works out to an average of $5,440 per person, roughly twice the level of per capita health spending in other industrialized countries. Yet in most of those countries, 100% of the population has health coverage, according to the report.

The institute’s previous reports quantified some of the costs of an uninsured America. They included 18,000 premature deaths each year, developmental and learning delays in children, family bankruptcies, reduced access to medical specialists and hospital care and $65 billion to $130 billion a year in lost economic productivity.

“This isn’t just a matter of taking care of the uninsured, this is a matter of enlightened self-interest for everyone in this country,” Kellermann said. “We can’t afford not to cover the uninsured.”