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Health Care Insurance Must be Made Universal

by Lawrence Wallack

This week the prestigious Institute of Medicine published a report calling for the President and Congress to achieve universal health coverage by 2010. This would allow the United States to relinquish its shameful position as the only industrialized country in the world that does not provide heath care for all its citizens.

Today, 43.6 million Americans are uninsured. Here in Oregon at last count 511,000 people lacked health insurance. If Measure 30 fails on Feb. 3 and the temporary tax passed by the Legislature is rescinded, this number could approach 600,000 as a result of cuts to the Oregon Health Plan. Most striking is that 106,000 of Oregon's children (almost 12 percent) do not have health insurance, a fact that puts them at risk for developmental problems and diminished opportunities throughout their lives.

Nationally, 80 percent of the uninsured live in working families. Many do not have access to coverage through their jobs or they just cannot afford it when it is offered. Some lose insurance when they become divorced from the spouse with coverage or when aspouse dies. In these difficult economic times, some must choosefood and housing over health insurance.

Why should those of us who have health insurance care about those who don't? If basic human values such as compassion, fairness and justice aren't sufficient, the latest report from the Institute of Medicine provides compelling evidence about why we all need to care. First, for most people being uninsured is not a choice they make but a burden they are forced to accept. Second, adults who are uninsured receive fewer services and have a higher risk of dying. Third, children in uninsured families use fewer medical and important preventive services. In sum, uninsured people are sicker, and when they do get treatment it is too little, too late and too costly.

We have a shared destiny with the uninsured. Insured people living in communities with a higher-than-average rate of uninsurance can face reduced availability of health care services, including primary care, emergency services and trauma care, and overtaxed public health resources. Health care institutions in these communities may not have the financial resources to provide uncompensated care without risking their viability.

Polls increasingly indicate that health insurance concerns are a significant worry even for insured people, who realize they are one pink slip or one increase in premiums away from losing coverage. Politicians are talking about what needs to be done to fix the problem.

How will we know if the politicians' plans will really make a difference? The Institute of Medicine report's most fundamental principle is that health care coverage should be universal; it needsto extend to everyone. The other four principles are that coverage should: Be continuous to allow for continuity of care even when people lose or change jobs, or get divorced or are widowed. Be affordable for individuals and families. People should not be put in a position of having to choose between health insurance and other basic necessities. Be sustainable for the society. This means that the system must be simple, cost effective and administratively efficient with mechanisms to control levels of use and cost inflation. Promote care that is effective, efficient, safe, timely, patient-centered and equitable. Preventive care, screening, mental health treatment and prescription drug coverage are important elements of an overall benefit package.

Health care coverage is a complicated issue, but these principles provide us with a tool to make sure that solutions being put forth can make a difference.

This piece originally appeared in The Oregonian on 1/16/04

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