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Coleman details recommendations
Institute of Medicine calls for universal health insurance


Saying small steps toward providing health insurance for all Americans are inadequate, President Mary Sue Coleman presented a report on behalf of the Institute of Medicine (IOM) of the National Academies that called upon Congress and the president to provide coverage for everyone in the country by 2010.

President Mary Sue Coleman (Photo by Martin Vloet, U-M Photo Services)

“The committee believes this is an urgent problem—work must begin immediately. There is no justifiable excuse for delay,” Coleman said during a Jan. 14 public briefing in Washington, D.C. Her remarks were preceded by comments from former Senate Majority Leader and presidential candidate Robert Dole and former Democratic Rep. Paul Rogers of Florida.

In its sixth and final report on the status of the uninsured, the IOM Committee on the Consequences of Uninsurance, which Coleman co-chairs, gathered and analyzed evidence about the nation’s current and historic approaches to health insurance. The committee’s intent was not to offer specific strategies for providing health insurance to the approximately 43 million Americans who currently are uninsured, Coleman said. Its goal was to help policymakers and lawmakers by setting forth the rationale and principles for universal coverage.

With the election year gearing up, Dole said many presidential candidates are addressing the issue of the uninsured.

“It couldn’t come at a better time,” Dole said of the IOM call for action. The former senator, who had his own experiences to relate about trying to pass legislation for the uninsured, said the key is to get support from Republicans and Democrats alike.
“Most legislation that lasts is bipartisan,” he said. “There are people up there in both parties who think about this every day, who see it with their constituents every day, who need a support group like this.

“[But] how do we get there, how do we pay for it and how do we make it work?” Dole asked.

Rogers, who for eight of his 24 years in Congress served as chair of the House Subcommittee on Health and the Environment, and who currently co-chairs the National Coalition on Health Care, said it may not be well known, but support is building for a national system of health care.

“Public opinion polls now are showing that up to 80 percent of Americans are ready for fundamental health care reform that achieves universal coverage,” he said. “The cause is attracting attention, and support is growing and it will continue to grow.”

The final IOM report, “Insuring America’s Health: Principles and Recommendations,” culminated three years of in-depth study of the effects of lack of insurance on individuals, families, communities and the country, Coleman said. Among other findings, the reports noted:

• 18,000 deaths a year can be attributed to a lack of health insurance
• Eighty percent of Americans who are uninsured have jobs or are part of families in which someone works
• Uninsured Americans get about half of the care those with insurance receive, and they forego preventive care, such as blood pressure and cancer screenings, and annual check-ups for their children, as well as routine care of chronic conditions such as diabetes and heart disease
• Half of uninsured children visited a physician in 2001, compared with three-quarters of insured children
• The United States loses the equivalent of $65 billion to $130 billion annually as a result of poor health and early deaths of uninsured adults
• Tax dollars paid for an estimated 85 percent of the roughly $35 billion in un-reimbursed medical care for uninsured people in 2001

Coleman’s co-chair on the committee, Dr. Arthur Kellerman, professor and chair of the Department of Emergency Medicine at Emory University in Atlanta, said the burden caused by un-reimbursed care creates financial hardship for health care facilities, causing many to reduce beds, cut back on some services or close entirely.

“They’ve had to take the airline approach to this problem, which is to try to fill every seat,” Kellerman said. “That doesn’t work well when you have unscheduled admissions from the ER from a car crash, a heart attack or a stroke. That is driving this problem.

“If we don’t have a system that works for everyone, it may not be there for us and for our families, even with our health insurance, if the system isn’t sufficiently supported to function the way it needs to function.”

In making its recommendations, the committee advanced what it called five guiding principles to judge any proposed solutions to insuring all Americans:

• Health care coverage should be universal
• Health care coverage should be continuous
• Health care coverage should be affordable to individuals and families
• The strategy for health insurance should be affordable and sustainable for society
• Health insurance should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered and equitable

To view the six reports, visit http://www.iom.edu/report.asp?id=17632. To learn more about the IOM, visit http://www.iom.edu/.

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