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Coleman addresses the uninsured during Waggoner lecture

Many solutions to the problem of increasing numbers of uninsured Americans will have to come from the academy, President Mary Sue Coleman told an overflow crowd in the U-M Health System Ford Amphitheatre Oct. 9. During the 7th annual Raymond W. Waggoner lecture on “Ethics and Values in Medicine,” Coleman urged those in attendance to help identify members of the University community who can influence a major policy shift in the way health care is delivered.

In her talk, “Care Without Coverage: Too Little, Too Late,” Coleman outlined findings from three reports of the Institute of Medicine (IOM) Committee on the Consequences of Uninsurance. Coleman co-chaired the committee that evaluated a number of studies on the uninsured and found that those without coverage do not receive adequate health care, and when they do it often is too late.

Her lecture comes on the heels of a U.S. Commerce Department Census Bureau report showing the number of uninsured Americans increased by 1.4 million between 2000 and 2001. The report issued last month estimates more than 41 million people are without health insurance, including 8.5 million children.

“Access to clinical care, like that afforded to most of us in this room, is unaffordable or unavailable to far too many people in this country,” Coleman said. “The number of medically uninsured is growing in Michigan, as well as the rest of the nation.”

Coleman used as a case in point the recent announcement that the Hope Clinic in Ypsilanti is having to turn people away because it cannot handle the increased demand for free medical services. Volunteer physicians, nurses and other health care employees, many of whom are affiliated with U-M, staff the clinic.

“With rising health care costs and increasing numbers of employees being asked to pay more for their health care costs, there’s little relief in sight,” Coleman said.

Those without coverage do not seek preventative services like prenatal care, mammograms, pap smears and colorectal screenings, Coleman said. They also are less likely to receive routine check ups during which chronic conditions like hypertension, cardiovascular disease, cancer and diabetes may be uncovered. The result is that the uninsured are sicker, their illnesses often are found when they are in an acute stage, and they die sooner than those with insurance.

She said much of the problem with the nation’s health care system is that insurance goes to the individual, not the family. IOM estimates that one in five members of each family is uninsured. With a system that is employment-based, Coleman said there also are gaps in coverage as workers move from job to job.

The IOM makes a strong case for finding some means to provide coverage for all Americans, but Coleman said it will take a major shift in policy and mindset to solve the problem of the uninsured.

Despite what she calls the amazing success of the Medicare system for older adults, the United States has been resistant to a national insurance plan dating back as far as one proposed by President Harry S. Truman in the late 1940s.

“We have this fierce sense of individualism and an unreasonable fear of the government,” she said. “We’re going to have to confront this situation and make a collective decision on how to allocate resources.”

Coleman ended her remarks with a challenge to participants to get involved: “To know is not enough; we must comply. To be willing is not enough; we must do.”

The Waggoner lectureship was named for the late Dr. Raymond Waggoner, who died in June 2000 at the age of 98. He was chair of the Department of Psychiatry for 33 years, and was a noted psychiatrist, medical administrator and government advisor. Waggoner was one of the first to suggest that mental illness is both an emotional and physical problem. He had a strong interest in the area of medical ethics, which led his department to begin the lectureship in his name.

To read the IOM reports, “Care without Coverage: Too Little, Too Late” and “Health Insurance is a Family Matter,” go to To read a summary of “Coverage Matters: Insurance and Health Care,” go to


A profile of the uninsured in America >

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