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From the January 15, 2004 print edition
San Francisco Chronicle
New Campaign to insure Americans
Medical panel calls universal care crucial
Victoria Colliver
As a solution to the country’s growing number of uninsured residents, an influential health advisory group urged the United States in a report released Wednesday to adopt universal health coverage by 2010.
Health care advocates describe the call for universal coverage as a bold move on the part of the independent Institute of Medicine, a prestigious panel of medical professionals and academics affiliated with the National Academy of Science that advises on public health policy.
"The question is now whether or not it will be listened to," said Anthony Wright, executive director of Health Access, a coalition of California community and labor groups. "Insuring everybody is not a ‘feel good’ issue. It’s an imperative for the health, economy and security of our country."
The report, "Insuring America’s Health," comes just days after the federal government said that health spending jumped 9.3 percent in 2002 - the largest increased in 11 years - and that it now accounts for 15 percent of the nation’s economy, or gross domestic product.
Much of the increase is fueled by the rise in hospital costs and other expense such as prescription drugs and improvements in medical technologies.
But by far one of the most pressing problems in health care remains the growing number of uninsured - a population the U.S. Census estimates at 43.6 million Americans.
California, the most populous state in the country, has the greatest number of uninsured, 6.4 million, or 18.2 percent of the state’s residents.
The Bush administration’s health and human services secretary, Tommy Thompson, said universal coverage by 2010 is not realistic.
In a meeting with reporters this week, Thompson told the Associated Press, "I just don’t think it’s in the cards. I don’t think that administratively or that legislatively it’s feasible."
While the report calls for universal coverage, which simply means covering everybody, it does not recommend any strategies on how to attain it.
"There is no single pathway to achieving universality by 2010. It will be debated in a political context," said Dr. Sandra Hernandez, chief executive of the philanthropic San Francisco Foundation and one of the 16 members of the IOM committee that wrote the report, which is the culmination of a three-year, six-part study.
The problems with the existing health care system, with some sort of universal or expanded coverage as a solution, have become a major topic of discussion among Democratic presidential hopefuls.
Universal coverage can come in a variety of forms from a national or single-payer plan, which would essentially dissolve the current insurance system and replace it with a government-run plan, to using tax credits in order to subsidize mandates employer or individual coverage.
California has been at the forefront of employer-mandates health coverage with the passage of SB2, a law that would require many employers to pay for their employees’ coverage starting in 2006. The law, however, remains in legal limbo, as courts wrangle over an effort by businesses to overturn it and claims that the referendum’s signatures were improperly collected.
Another less radical option involves using tax credits to extend public programs, which would keep the current private insurance system in place and give low-income people the choice of enrolling in a public plan or purchasing subsidized private coverage.
The report proposes using five guidelines to judge potential solutions. Three of the guidelines recommend the coverage should be universal, continuous and affordable to society.
While the report calls for federal solution, it highlights several local programs trying to fill in the coverage gaps, including the Alameda Alliance for Health in Alameda County, where about 109,000 people under 65 remain uninsured.
The Alameda Alliance is a private, nonprofit managed-care plan that manages to cover more than 95,000 people through a combination of public and private funding including Medi-Cal and Healthy Families, foundation grants and tobacco settlement dollars from the country.
"The Alliance has been doing what we can to make a dent in our neck of the world, but we realize we can’t do it by ourselves," said Nina Marayuma, director of development and government relations for the plan.
The report coincidentally came out the same day a s a report on the administrative excesses of the current health system by researchers at Harvard Medical School and Public Citizen, Ralph Nader’s consumer advocacy group.
The study, which appears to bolster the IOM’s findings, claims the health care bureaucracy - or the administration costs of insurers, hospitals, doctors, nursing homes, etc. - cost the United States$399.4 billion last year and that a national; health system could save the country at least $286 billion a year.
In California, the authors say the state will spend $45 billion on bureaucracy this year and would have enough to spend$5,000 on health care for each of the state’s uninsured resident’s from the savings reaped from a single payer system.
The associated Press contributed to this report.