The ACP Advocate Blog
by Bob Doherty
Wednesday, November 18, 2009
How important is it really to provide health coverage to all?
Many issues relating to health reform are creating deep divisions among Americans, including taxes, mandates, and the public plan option. Yet I had assumed that there was a general consensus that everyone should have access to affordable coverage, and the disagreement was mostly over how to achieve it, not whether this should be a major objective.
I was wrong: many critics of the current effort believe that covering everyone is not all that important, at least when compared to other priorities.
For instance, the House GOP's health reform proposal, according to the Congressional Budget Office, would reduce "the number of nonelderly people without health insurance by about 3 million in 2019 and leaving about 52 million nonelderly residents uninsured. The share of legal nonelderly residents with insurance coverage in 2019 - 83 percent - would be roughly in line with the current share." Instead, the GOP plan focuses more on providing more (and less costly) coverage options for people who already have health insurance.
In a recent Washington Post column, Robert Samuelson makes the case why providing health insurance to everyone is less important than keeping government spending under control:
" . . almost everyone thinks that people in need of essential medical care should get it; ideally, everyone would have health insurance. The pursuit of these worthy goals can easily be projected as a high-minded exercise for the public good. It's false for two reasons. First, the country has other goals - including preventing financial crises and minimizing the crushing effects of high deficits or taxes on the economy and younger Americans -- that 'health-care reform' would jeopardize. And second, the benefits of 'reform' are exaggerated. Sure, many Americans would feel less fearful about losing insurance; but there are cheaper ways to limit insecurity."
Is Samuelson right that the issue is mostly about reducing "insecurity?" For many of the uninsured, it is much more than that. According to a new Harvard study, people without health insurance are 40 percent higher risk of death than those with health insurance, and 45,000 Americans of them die each year as a consequence. Similarly, in 2002, the Institute of Medicine found people without health insurance are more likely to suffer poor health and die prematurely. And in 2008, the Urban Institute updated the IOM report and estimated that 137,000 people died from 2000 through 2006 because they lacked health insurance, including 22,000 people in 2006.
Providing all Americans with access to affordable health insurance coverage is a top priority for the American College of Physicians, and one of the many reasons why the College has expressed support for many of the key policies in H.R. 3962.
I am ambivalent about the question of whether health care is a right, but I firmly believe, as does the ACP, that covering everyone is the right thing to do. I don't disagree that the country has other important goals, as Samuelson argues, like minimizing crushing deficits. But if the annual death toll of not having coverage is akin to the total U.S. deaths suffered during the Vietnam War, how can preventing such deaths not be an essential purpose of health reform?
Today's questions: Do you believe that uninsured people are more likely to die prematurely? Do you believe that providing all Americans with health coverage should be an essential purpose of health reform?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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