What Sort of Health Care Reform?

In 2004, the Institute of Medicine, one of the congres-
sionally chartered United States National Academies, published the conclusion of its multi-year study of health care in the United States in the form of "a set of guiding principles based on the evidence reviewed in the Committee's previous five reports and on new analyses of past and present federal, state, and local efforts to reduce uninsurance."

Most of what is in those reports is publicly available, with percentages updated through 2007 or later, so I won't go into detail about those numbers except to say they have tended to become more dire in the five years since publication of the final IOM report, Insuring America's Health: Principles and Recommendations (e.g. the number of excess deaths attributed to uninsurance rose from around 18,000 Americans in 2004 to around 22,000 in 2006—that's about a 20% increase in the number of Americans who died for lack of medical coverage).

Here are a few facts uncovered in the IOM's meticulously evidence-based reporting that I have not found in the discourse this year, followed by the "guiding principles" in the report:

• About four out of five uninsured people in the U.S. are citizens.

• Just over 55% of uninsured Americans are in households with at least one family member who is fully employed. Nearly 14% are in households with two full-time workers.

• The cost of employment-based insurance increased by 260 percent between 1977 and 1998, and the employee’s share increased by 350 percent — while median household incomes only increased by 17 percent (all in constant 1998 dollars)—you know how those costs have accelerated in the new century.

• About 58% of uninsured adults in the reporting period had changed or lost jobs in the previous year—this is well before the job collapse of 2008-09.

• The cost to the U.S. economy in lost productivity from uninsured Americans ran as high as $130 billion a year—nearly twice as much as it would have cost to insure those Americans outright.

The IOM report made the following recommendations in the strongest terms:

1. Health care coverage should be universal—nobody left out.
2. Health care coverage should be continuous—no gaps due to job status.
3. Health care coverage should be affordable to individuals and families—no more medical bankruptcies.
4. The health insurance strategy should be affordable and sustainable for society—weighing all outcomes, costs and savings over time, U.S. health care should benefit the nation, not run it into the ground.
5. Health insurance should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable—what's not to like about better health care?

You can read all this for yourself and I hope you will. The individuals who conducted the studies and analysis and issued the guidelines were a blue-ribbon, nonpartisan committee of genuine experts. As far I can judge, no stakeholders in the future of U.S. health care were left unrepresented with the possible exception of lawyers.

They concluded with the charge:

The Committee calls on the federal government to take action to achieve universal health insurance and to establish an explicit schedule to reach this goal by 2010.

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.

This picture can become reality, with the right mix of leadership and political will. Unchecked, the costly consequences of the status quo are too large to sustain. It is time for our nation to extend coverage to everyone

Yes, imagine. And then communicate the substance of these recommendations to your U.S. senators and representatives—especially the knuckleheads who act as if they've never heard of the report they commissioned the Institute of Medicine to research and write (I'm looking at you Congressman Bilbray). The health care reform we need calls for the right mix of leadership and political will. This may be one of those instances in which, if the people show the will, the leaders will follow.

But don't mistake this for a political game. "Unchecked," the IOM declares, "the costly consequences of the status quo are too large to sustain (I think the economist on the committee crafted that sentence)."

"It is time for our nation to extend coverage to everyone." Now. How are we going to do it?