NU Online News Service, Jan. 14, 2004, 6:03 p.m. EST – The United States should strive to enact some type of universal health care by 2010, says a new report from the Institute of Medicine, Washington.[@@]

The institute, a private, non-profit organization that advises the government on health care issues, says the lack of health insurance in the United States has become a critical problem that can and should be eliminated.

The institute does not recommend any specific path to universal health care in its report, saying that is beyond its purview.

However, it says any proposed solutions should be judged by several guiding principles.

- The coverage must be truly universal, covering everyone living in the United States.

- Coverage must be continuous, because gaps in coverage can lead to diminished health.

- Coverage should be affordable for individuals and families.

- Coverage should be affordable and sustainable for society, meaning there must be mechanisms to control inflation and encourage use of cost-effective services.

- Coverage should enhance health and well-being, by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered and equitable.

The institute notes that 4 prototype strategies have been proposed to achieve universal care.

The strategy that would require the least change to the current system is a major expansion of public sector health care and a new tax credit.

For example, the institute says, Medicare could be expanded to cover 55-year-olds who pay a premium while a tax credit would be provided for moderate income individuals who are not covered by employer-based insurance to purchase individual policies.

The second strategy would be to mandate that employers provide coverage, with a subsidy available for certain employers. Individuals who are not covered by an employer plan would be required to buy individual coverage or enroll in a public program.

The third strategy would be to establish an individual mandate and provide a tax credit. Individuals would have a responsibility to provide health insurance for themselves and their families in the private market, with each person eligible for a refundable tax credit.

The fourth strategy would be to create a single-payer system that would be funded and administered federally, but which would use contractors and private health plans to review claims and process payments.

The institute says federal leadership and federal dollars will be necessary to eliminate uninsurance.

“Our nation already invests in the health of its people by directly providing health insurance for some and by offering tax subsidies to support health insurance for others,” the institute says.

“Insuring those who remain or become uninsured will require a substantial employer contribution, tax incentive or a nearly free public coverage program,” the institute adds.

The federal government should take action to achieve universal coverage by 2010 and establish an explicit schedule to reach that goal, the institute concludes.