Health insurance for uninsured will improve care for all Americans

PERHAPS your family earns enough to be called "rich" — and to be taxed to help pay for expanding health-care coverage to the uninsured under the U.S. House's new bill. Or more likely you're just lucky enough to get health coverage through your employer or are covered by Medicare.

Either way, you might feel removed from the estimated 47 million U.S. residents who lack health insurance. Sure, you may empathize with their plight: not quite poor enough for Medicaid or old enough for Medicare, and unable to afford their own insurance.

Still, you probably don't expect that covering the uninsured will help you out. But a recent report from the National Academy of Sciences' Institute of Medicine (IOM) suggests, surprisingly, that it will. The report, called "America's Uninsured Crisis," concludes that the U.S. health-coverage crisis has dire consequences for all of us, including people with good health insurance — and for health-care providers too.

"America's Uninsured Crisis" describes how high rates of "uninsurance" have harmed the health care that's available to people with good health insurance. As more and more people in an area become uninsured, it leads to deterioration in community services like access to emergency rooms, primary medical care and certain specialists needed in emergencies. Such declines are now visible in many U.S. cities, towns and neighborhoods.

A recent study the IOM commissioned suggests that when uninsurance rates are high, it's harder for even insured adults to get the health care they need. And doctors, who are generally paid more for providing more tests and treatments, may be more likely to believe that they can't make clinical decisions in the patient's best interest without losing income. In response, even many public-service institutions such as nonprofit hospitals are preferentially building profitable "service lines," typically those involving highly rewarded surgical procedures and diagnostic tests that can be scheduled in advance. These service lines are usually built at the expense of more basic and valuable services like maternity care, trauma services and acute care.

Meanwhile, with its dwindling supply of general internists or family-practice doctors, the nation's primary-care system is on life support and in danger of dying altogether as graduates of U.S. medical schools choose more-lucrative specialties instead.

Of course, the uninsured bear the brunt of the negative impact of lack of insurance. From 2000 to 2004, an IOM committee issued a landmark series of six reports on the consequences of uninsurance. As you'd expect, these reports confirmed that uninsured people — children and adults alike — have worse health and die sooner than do those with insurance. The final 2004 report recommended that the president and Congress develop a strategy to achieve universal coverage by 2010. Yet uninsurance has only risen, with no end in sight. Almost unwittingly, we have apparently accepted living with continuously rising rates of uninsurance.

The conventional wisdom has held that the United States has failed to address our uninsured crisis because people with insurance and the industry serving them refuse to give up their benefits or privileged positions. Many saw insuring the uninsured as an unnecessary and undesirable redistribution of wealth. But the IOM's most recent report questions this view.

And just in time: Right now our elected members of Congress along with President Obama are engaged with major health-care players, attempting to fashion a plan for health-care reform. Ideally, it will curtail overtreatment while extending coverage to all Americans. The IOM report tells us that we need a solution to America's uninsured crisis.

Too many Americans, more than one in six under age 65, are without health insurance. Universal access to adequate health insurance is clearly in the self-interest of all Americans, including those who now enjoy health-insurance coverage, people who earn enough to be taxed under the new bill, and the providers of health services. It's good for all of us.

Dr. Eric B. Larson is executive director of Group Health Center for Health Studies.