Why the College must speak up for the nation's uninsured

Would any of you allow a patient to suffer needlessly if you could help? Of course not. At the core of our professionalism is the responsibility we have to our patients.

We fulfill that responsibility every day by working with our patients to help improve their health and guide them through the health care system. In my view, however, we need to do more. I propose that we also must fulfill a broader professional responsibility, one that can be best accomplished through our collective efforts as members of the College.

It is time for us to address the unconscionable fact that more than 43 million Americans lack health insurance. This fundamental problem in our health care system leaves too many people with impaired access to health services, from primary prevention to tertiary care. Many of these individuals must live with the daily mental anguish of worrying whether an unforeseen illness will rob them of their ability to provide for their families.

To address this issue, the Board of Regents recently voted to fund a major initiative known as the Decision 2000 campaign, which aims to make the problem of the uninsured a key issue in the year 2000 presidential and congressional elections. Between staff time and other expenses, the College is devoting more than $1 million to this effort. (See "College to spend nearly $1 million to make access a campaign issue.")

I would like to share my views on why this campaign deserves such an important investment of the College's time and resources, and why we have a responsibility, both as individuals and members of ACP-ASIM, to get involved.

Risk factors

Many Americans believe a lack of health insurance is simply an inconvenience. After all, they argue, there is always some way to get health care, either through charity care or access to the emergency room.

In reality, however, lack of health insurance is associated with a complex set of risk factors. Consider the following statistics regarding the premature mortality associated with a lack of health insurance:

The 1993 National Health and Nutrition Examination Survey found that the adjusted risk of death was 25% higher for uninsured patients than for the insured.
A 1993 study on breast cancer found that the adjusted risk of death was 49% higher for uninsured women than for insured women during the four to seven years following breast cancer diagnosis.
A 1991 study found that the uninsured were up to three times more likely to die in the hospital than their insured counterparts.

These are only three examples from the literature establishing a clear link between poor health and premature death from a lack of insurance.

Our mission

Some of you may agree that the uninsured represent a serious problem but wonder why the College should get involved. ACP-ASIM's mission statement calls on the organization "to advocate responsible positions on individual health and on public policy relating to health care for the benefit of the public, our patients, the medical profession and our members."

To meet this mission, ACP-ASIM has created the Decision 2000 campaign to make America's opinion leaders and the general public aware that a lack of health insurance is a serious risk factor leading to unnecessary death and disease. A critical goal of the campaign is to have every presidential and congressional candidate make a pledge to address the problem immediately after taking office.

The Decision 2000 campaign will encompass a broad range of activities to draw attention to the problems that the uninsured face. Some initial activities include:

Placing advocacy advertisements in publications such as the Washington Post and Roll Call that are regularly read by national opinion leaders.
Sponsoring special events, such as press briefings and conferences, aimed at promoting the issue to the national press.
Commissioning studies to shed additional light on the problems of the uninsured and creative ways to address them.
Leveraging our influence with groups such as the Physician Work Group on Universal Coverage, the Catholic Health Association and the National Coalition on Health Care.
Activating the College's grassroots network of more than 2,000 internists who serve as Key Contacts to get directly involved in the 2000 presidential and congressional elections.

The College's image

The Decision 2000 campaign will also offer important advantages to ACP-ASIM. By taking on a leadership role in this issue, we help secure a seat at the table when important decisions are made. By launching our effort now, we also help make sure that we will be a respected—and effective—voice in future debates.

In addition, the campaign will raise awareness about both ACP-ASIM as an organization and about internal medicine as a specialty. The target audience will be Washington opinion leaders, including elected officials, government policy-makers and journalists.

We believe that we have designed a program that will make a significant contribution to the debate on health care for all Americans, as well as an important and lasting contribution to the public image of internal medicine.

More importantly, this program allows us to meet our professional responsibility to act as patient advocates. To me, the question is not whether we should undertake this program, but rather how we can best make it successful.

I hope that you will all join with me in this important effort in the coming year. Please feel free to contact me at waddingt@rsh.net if you would like to share your thoughts on the Decision 2000 campaign.

—Whitney W. Addington, FACP