Universal Health Coverage By 2010 Should Be U.S. Aim, Institute Says

Washington

The United States should strive to enact some type of universal health care by 2010, says a new report from the Institute of Medicine.

The Institute–a private, nonprofit group that advises the government on health care issues–says the lack of health insurance in the U.S. 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.

First, it says, the coverage must truly be universal, covering everyone living in the United States.

Second, the Institute says, coverage must be continuous, since gaps in coverage can result in diminished health.

Third, the Institute says, coverage should be affordable to individuals and families. The high cost of coverage, it says, is the main reason people give for being uninsured.

Fourth, the Institute says, coverage should be affordable and sustainable for society, meaning there must be mechanisms to control inflation and encourage use of cost-effective services.

Fifth, the Institute says, 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, the Institute says, is 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 purchase individual coverage or enroll in a public program.

The third strategy is to establish an individual mandate and provide a tax credit, the Institute says.

It would be the responsibility of individuals to provide health insurance for themselves and their families in the private market, with each person eligible for a refundable tax credit, it says.

The fourth strategy, the Institute says, is to create a single payer system that would be funded and administered federally but which uses 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” it says.

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


Reproduced from National Underwriter Life & Health/Financial Services Edition, January 23, 2004. Copyright 2004 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.