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Summer 2004 Vol. 4 No. 2



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20/20


Uninsurance Is Bad for Your Health

BY MARY SUE COLEMAN AND
ARTHUR KELLERMANN

Mary Sue Coleman, photo courtesy University of Michigan

"I have become convinced that the persistence of a large proportion of our population under 65 without health insurance is undermining the very fabric of health care in this country. As medical interventions become ever more effective in determining health status and quality of life, the consequences of uninsurance will only pose greater risk to our nation."

Mary Sue Coleman, Ph.D., Co-Chair, Committee on the Consequences of Uninsurance

Medicine today has the ability to prevent many diseases, alleviate symptoms, and extend life, especially when conditions are detected early. People without health insurance often miss these benefits because they cannot afford regular visits to a doctor. This situation is clearly bad for the more than 43 million uninsured people in this country, but what may not be so readily apparent are all of the associated effects of being uninsured.

Between September 2000 and February 2004, a 16-member committee of the Institute of Medicine attempted to uncover these problems and issued six reports on the health, social, and economic consequences of the lack of health care coverage for individuals, their families, entire communities, and the nation as a whole. In commissioning the series of reports, our sponsor, the Robert Wood Johnson Foundation, emphasized the importance of not only consolidating what is known about uninsurance and its consequences, but also communicating this knowledge in an unbiased, nonpartisan way to mobilize debate. Generous funding of the project furthered our communications objective by allowing IOM to print thousands of copies of each report and its executive summary, and shorter products in both English and Spanish for dissemination to audiences across the country, from congressional and state legislative staff to health care advocates at the grass-roots level and hospital and clinic administrators.

Arthur Kellermann, photo courtesy Emory University

"As an emergency physician, I routinely deal with the human costs of uninsurance. Nonetheless, I was surprised by both the magnitude and pervasiveness of the ill effects we observed. Lack of health insurance not only harms the uninsured and their families -- it is threatening the integrity of the health care system on which everyone depends."

-- Arthur Kellermann, M.D., M.P.H., Co-Chair, Committee on the Consequences of Uninsurance

Each of the reports built on the one before it. Our first   -- Coverage Matters: Insurance and Health Care -- was an overview of the issues, followed by two reports that addressed the health consequences of uninsured status and its psychosocial and economic impacts on families   --  Care Without Coverage: Too Little, Too Late and Health Insurance Is a Family Matter . The next two reports   --  A Shared Destiny: Community Effects of Uninsurance and Hidden Costs, Value Lost: Uninsurance in America -- looked at uninsurance as a type of population risk factor affecting the health care system at the community level and the national economy. Our final report   --  Insuring America's Health: Principles and Recommendations -- called on the president and Congress to implement universal health insurance coverage by the year 2010 and recommended five principles to guide reform efforts.

The culmination of our years of work took place on Jan. 14, 2004, when we released our final findings to a standing-room-only crowd at the National Press Club. This release was intended to galvanize public discussion at the beginning of a presidential election year by bringing new and trustworthy information to bear on the issue of health insurance reform. Our guests of honor, retired Senator Bob Dole and retired Representative Paul Rogers, spoke enthusiastically about the need for bipartisan cooperation to identify practical solutions. A video news release disseminated information about the report series to an estimated 6.6 million viewers across the country. Dozens of editorials and op-eds in the national and regional press further highlighted the importance of addressing uninsurance without delay.

In the weeks and months since the release of Insuring America's Health, print, radio, and television journalists have reported on many of the committee's conclusions and recommendations. This has brought our work into the mainstream and increased public awareness about the difficulties that the uninsured face obtaining health care and the threat that uninsurance poses to individuals. For example, an estimated 18,000 working-age adults who are uninsured die prematurely each year because they lack access to effective health services. The word has also spread about the impact that uninsurance has on health care institutions and providers at the community level, and the costs to society of poor health for tens of millions adults without coverage -- an estimated $65 billion to $130 billion a year.

After analyzing the extensive evidence about the adverse health, economic, and societal effects of uninsurance, it is clear that our nation can no longer afford to ignore the problem. We must insure everyone, and achieve this goal by 2010. Nothing less will do.



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Copyright 2005 by the National Academy of Sciences