AIDS TREATMENT NEWS "alert" January 15, 2004
John S. James

On January 14 the Institute of Medicine (IOM), a Congressionally chartered but independent organization created in 1970 "to serve as adviser to the nation to improve health," released a report and fact sheets asking the president and Congress to act so that everyone living in the U.S. has health insurance by 2010. The report assembles facts we all can use to make the case that the current system must and can be changed. For example:

• Uninsured children and adults are sicker and die more often, as cancer and other diseases are diagnosed too late. Uninsured persons injured in an automobile accident get less services in hospitals and have a 37% higher death rate than those with health coverage. Lack of health insurance causes 18,000 unnecessary deaths every year in the U.S. Currently, 43,000,000 Americans are uninsured.

• The cost of the employee's share of health insurance increased 350% (in constant dollars) from 1977 to 1998, while the median income only increased 17%.

• Four out of five uninsured Americans are members of working families. A quarter of U.S. workers are not offered health insurance at all by their employer. If they buy their own policy it usually costs much more than the same insurance purchased by a group, especially if they have a chronic health condition. If they do not have insurance and get sick, they usually have to pay much more for the same medical services, since insurance companies can negotiate discounts with doctors, hospitals, pharmacies, and others.

• Four out of five without health insurance in the U.S. are U.S. citizens -- although immigrants are more likely than others to be uninsured.

• Of the 7.8 million uninsured children in the U.S. today, half are actually eligible for insurance under SCHIP (State Children's Health Insurance Program) or Medicaid. Often they are kept out by complex enrollment or re-enrollment procedures.

• It would almost certainly cost less to provide insurance to everyone than to continue the current system. The cost of covering all the uninsured has been estimated as between 3% and 5.6% of total U.S. healthcare cost.

• The U.S. spends more per person on health care than any other nation -- 14% of gross its domestic product -- but is 25th in male life expectancy and 19th in female life expectancy among 29 developed countries.

The report recommends five key principles for evaluating health insurance -- that it be universal, continuous, affordable to individuals and families, affordable and sustainable for society, and should "enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable." It does not recommend a particular reform strategy, but evaluates four of them, including single payer, on how well they meet these recommendations.

"Imagine what the country would be like if everyone had coverage -- people would be financially able to have a health problem checked in a timely manner, to obtain preventive and primary care, and to receive necessary. appropriate and effective health services. Families would have security in knowing that they had some protection against medical bills undermining their financial stability. Key community providers and health care institutions could provide care to those who need it without jeopardizing their financial stability."

The new report, Insuring America's Health: Principles and Recommendations, is the last of a series of six IOM reports "that offers the most comprehensive examination to date of the consequences of lack of health insurance on individuals, their families, communities, and the whole society." Copies of all six are available at: http://www.iom.edu/report.asp?id=17632 or through: http://www.iom.edu

Comment

Access to medical care for HIV and other illnesses is getting much worse today in the U.S. The comforting myth that people in this country can get treatment and do not die from lack of money (never wholly true) is going away. The 18,000 unnecessary U.S. deaths a year from lack of health insurance is probably an underestimate, since the real facts that contribute to or directly cause a death often do not enter any official statistics.

It is increasingly clear that the U.S. healthcare mess continues not in spite of abuses, but because it allows abuses. For example, Abbott could not have raised the price of ritonavir five fold overnight, as it did last month, in a single-payer system. Nor would that system support a multi-billion-dollar HMO industry that exists only to deny care that doctors and patients agree is appropriate. (The IOM report proposes incentives rather than gatekeeping to avoid overuse of expensive treatment options.)

There have been successes, but often the word does not get around. Voters have consistently supported good-faith, workable healthcare reform. Here in Pennsylvania, the state recently implemented "adultBasic" health insurance for $30 per month for persons earning less then twice the Federal poverty level; it includes primary care and specialists, unlimited hospitalization, emergency services, diagnostic tests, maternity, and some rehabilitation, but no prescription drugs. This program, funded by tobacco-settlement money, has over 40,000 enrolled, and currently has a waiting list (those on the list can purchase the insurance at the full cost to the state Department of Insurance, until they can be accepted at the $30 rate).

If one state can this well without Federal leadership or money, imagine what could be done if the national consensus that already exists for healthcare reform were better mobilized.

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