President Coleman focuses on health insurance
gap
From President Coleman’s editorial in the Detroit Free Press,
6/1/03.
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Mary
Sue Coleman |
I am one of the 240 million Americans who have health insurance,
yet my access to health care services, and the health of my community,
are affected by the presence of more than 41 million uninsured Americans.
Each person without coverage means greater burdens on the financial
and physical capacities of the health care system on which all of
us rely.
For the past two years, I have co-chaired a committee of the National
Institute of Medicine, which is examining the consequences of the
lack of health insurance. We have discovered not a schism between
those with coverage and those without, but a shared destiny. Through
our research and discussions, the committee has found almost universal
acceptance of the need for universal coverage.
Overall, about one in 10 Michiganders lacks health insurance,
compared to a national average of about one in six among people
younger than 65, when Medicare kicks in. In Texas, one in four lacks
insurance.
But being better than average does not mean Michigan is without
problems. The substantially higher rates of the uninsured in certain
communities result in fewer dollars to support health care and the
local economy there. That threatens both health care institutions
and residents’ quality of life, as jobs are lost and as health
services become less accessible.
In other words, inadequate health care for some translates into
health care and financial problems for all.
As our population ages, and when we face the kind of economic
problems we now face, the impacts of these problems are felt in
ever widening circles. The patchwork of programs and institutions
that substitutes for health insurance is fraying.
Detroit may be about to become a case study of how that process
plays out. The greatest concentration of people without health insurance
in Michigan is in Detroit. The estimated 180,000 residents without
coverage far outstrip the capacity of primary care doctors and free
clinics that serve uninsured patients. This has led to greater use
of local hospital emergency departments for routine health care.
Health care providers in America are social institutions and economic
entities. Hospitals began as charities and public protectors against
communicable disease. As medical knowledge grew, and as access to
health care became recognized as a social responsibility in many
areas of the country, more people were served, and health care costs
rose. Voluntary contributions became inadequate to support our health
care system.
Increasingly, we financed health care through insurance mechanisms,
private and public, and we pushed our health care providers to act
more like businesses. Hospitals and doctors faced energized purchasers
who wanted them to become more efficient. But the private enterprise
model is inadequate for health care. As a society, we will not deny
critical care to those who cannot pay. But we also do not provide
them with much of the care that doctors and public health professionals
deem necessary.
Those without health insurance pay for about one-third of their
own health care. The remaining two-thirds is uncompensated care,
a combination of charity and bad debt. In 2001, uncompensated care
amounted to roughly $35 billion, of which 75 to 85 percent was paid
for with public funds.
Extending health insurance coverage to everyone inevitably would
entail some unknowns, because we cannot anticipate every implication
and consequence.
Nonetheless, that is not a good reason to delay. No one in 1965
envisioned a Medicare program close to what we enjoy today, but
I do not know anyone who regrets its passage. While that program
has problems that need to be addressed and resolved, we have accorded
our elderly a measure of health, medical care and dignity that was
unimaginable before.
We who serve on the Institute of Medicine committee have worked
hard to define the problem; we are also working to define suggestions
for possible solutions.
The devil, as they say, is in the detail of the solutions, and
in our limited ability to anticipate all the impacts. But we should
not miss this opportunity to work toward universal coverage. We
have a window now, before the increasing demands of the baby boom
generation on health care services and dollars makes it even harder
for us to achieve what we all recognize as an appropriate role for
our society.
We must not fail.
Write to President Coleman at presoff@umich.edu or at Office of
the President, University of Michigan, Ann Arbor, MI 48109.
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