The second, he said, is the "it's my plan or the status quo" approach of many politicians.
Presidents and lawmakers have debated the costs and benefits of universal health coverage since 1939, and health insurance plans have been proposed and killed in virtually every Congress since President Clinton's health reform plan went down in flames 10 years ago.
For The Record
Los Angeles Times Friday January 16, 2004 Home Edition Main News Part A Page 2 National Desk 1 inches; 36 words Type of Material: Correction
Health-care spending -- An article in Thursday's Section A about an Institute of Medicine report on the uninsured incorrectly stated that U.S. spending for health care in 2002 totaled $1.55 billion. Actual spending was $1.55 trillion.
Since establishing Medicare and Medicaid in 1965, Congress has significantly expanded health coverage only once, with the 1997 creation of the state-federal Children's Health Insurance Program.
The institute's latest report, like the previous five, tried to sidestep the politics of how to expand health-care coverage. Instead, it offered five principles it said should be used to evaluate health reform proposals.
Acceptable strategies would provide health care that is available to all, continuous, and affordable for individuals, families and society. In addition, the report said, a good health-care program would include measures to control costs and improve quality.
Using those guidelines, the committee graded four generic health insurance strategies. It compared a single-payer plan, which would provide coverage through one standard benefit plan financed by the government, with a program that would expand Medicare and Medicaid and offer tax credits, a proposal that would require employers to offer coverage or pay into a government program, and a plan that would offer tax credits but require individuals and families to buy coverage.
The committee concluded that the single-payer plan was likely to achieve universal and continuous coverage. But the costs of such a plan would be high, it noted.
Each of the other plans would cost less but would only reduce, not eliminate, the number of Americans without insurance.
While each reform plan had its strengths and weaknesses, the committee concluded that the current health-care system met none of its guidelines.
The Centers for Medicare and Medicaid Services reported last week that the nation's health-care spending increased 9.3% in 2002, to a total of $1.55 billion. That works out to an average of $5,440 per person, roughly twice the level of per capita health spending in other industrialized countries. Yet in most of those countries, 100% of the population has health coverage, according to the report.
The institute's previous reports quantified some of the costs of an uninsured America. They included 18,000 premature deaths each year, developmental and learning delays in children, family bankruptcies, reduced access to medical specialists and hospital care and $65 billion to $130 billion a year in lost economic productivity.
"This isn't just a matter of taking care of the uninsured, this is a matter of enlightened self-interest for everyone in this country," Kellermann said. "We can't afford not to cover the uninsured."
