Back to Front PageVOLUME 6, NUMBER 4
 

Few matters of public policy require more urgent attention than does the lack of health insurance among so many of our fellow countrymen. Reliable estimates place the number of Americans without coverage at nearly 43 million - one out of every six among us!

No one knows better than we in academic medicine how devastating this statistic is. For openers, we know firsthand the magnitude of the resultant "safety net" burden. Composing just 6 percent of the nation's general, non-federal hospitals, teaching hospitals provide almost half of all the country's uncompensated care. While proudly accepting this long-standing burden as part of our societal mission, our ability to continue doing so is uncertain at best under today's mounting financial pressures.

But more important still, we also know firsthand the tragic and avoidable consequences for the health and well-being of those who lack insurance. Lost opportunities for preventing illness in the first place; lost opportunities for cure because of delayed diagnosis; risky (and expensive) hospitalizations to treat late-stage conditions otherwise amenable to safer, routine outpatient care. These and other direct results of being uninsured culminate in health outcomes far worse than those endured by other Americans. These are not new facts. We've known about this shameful reality of our society for years. And we've made some valiant runs at addressing it in the past, beginning with President Johnson's leadership in enacting the Medicare and Medicaid programs. Are we doomed to endure this unconscionable blot on our national escutcheon forever? Surely the answer must be "no"! Well, then, why not seize this very moment to launch the definitive effort to finally achieve universal coverage?

Why might now be the time? Let me recount the reasons. 1. We have a brand-new president and Congress. Transitions in our federal government have frequently provided opportunities for new initiatives. And a commitment to take action is precisely what's needed now more than ever to belie the common assumption that deadlock is unavoidable in our "split-down-the-middle" government. With lots of encouragement from the public, I believe Congress and the president could be persuaded to re-engage the fundamentally non-partisan, but fundamentally moral, issue of the uninsured. 2. We have a public that ranks this issue among its highest priorities. Poll after poll confirms that the public is aware and deeply concerned about the plight of the uninsured. Admittedly, the public has not yet rallied behind a single proposal for addressing the issue. But the soil of public opinion is clearly prepared for nurturing sensible approaches. 3. We have national organizations from across the political spectrum joining in calls for action and collaborating in efforts to craft overarching principles and proposals. As an example, the Health Insurance Association of America, the American Hospital Association, and Families USA recently announced their unprecedented agreement to pursue a common set of proposals for expanding coverage for low-wage workers, millions of whom are uninsured. 4. We have respected health economists offering practical solutions. For example, in a recent address to the Association of Academic Health Centers, Karen Davis, president of the Commonwealth Fund, laid out a realistic, step-by-step plan for accomplishing near-universal coverage by 2020. You can read her proposal in the December issue of the Archives of Internal Medicine. 5. And finally, we have the money. No longer can politicians claim that our country cannot afford the "luxury" of universal coverage. Our projected budget surplus, as Davis and others have noted, is more than sufficient to meet the need. We need only the political will to finally remedy this long-overdue ailment in our body politic.

In anticipation - and in hope - that specific measures to expand coverage will be emerging from Congress (and perhaps elsewhere) in the coming months, the AAMC Advisory Panel on Health Care Delivery is developing "Guiding Principles for the Evaluation of Proposals for the Uninsured." Knowing that any new strategy to achieve expanded coverage is likely to impact teaching hospitals and medical school faculty, we want to be well prepared with a set of criteria to guide the AAMC Executive Council in selecting the proposal(s) to support.

I'm proud that the academic medicine community has joined the struggle yet again to overcome this vestige of injustice in our health care system. I pray that this time we can make it happen.

 

Jordan J. Cohen, M.D.
AAMC President

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