GOVERNMENT & MEDICINE

AMA summit yields universal access tenets

The 1999 Health Sector Assembly sees adopting these principles as the first step toward covering the nation's 44 million uninsured.

By Geri Aston, AMNews staff. Dec. 6, 1999. - Additional information.

Washington -- When the Clinton health plan ended in disaster five years ago, political pundits predicted that universal health care access would be a politically taboo subject for decades to come.

But the goal of ensuring access to affordable health insurance for all Americans is shaping up to be the hot health care topic of 2000.

To make sure the issue once again grabs the public's and lawmakers' imaginations, a diverse gathering of more than 50 interest groups, led in part by the AMA, has developed a set of principles and premises for achieving universal coverage. The 1999 Health Sector Assembly included representatives from the medical, hospital, insurance, government, academic, business, policy and pharmaceutical communities.

Participants described the set of principles as the first step in what will be an ongoing effort to develop a plan for accomplishing universal access.

The groups were spurred to action by their belief that something must be done to expand health insurance to the more than 44 million Americans who lack coverage.

"In a country as prosperous as ours, we think that such neglect of so many of our citizens is unconscionable," said AMA Executive Vice President E. Ratcliffe Anderson Jr., MD, at the recent press conference where the principles were unveiled. "We believe the time has come for us to do something about it."

Assembly participants decried the impact of the problem: millions of Americans forgoing needed care or postponing it until they are sick enough to wind up in a hospital emergency department.

"We know that uninsured Americans tend to live sicker lives and die earlier than insured Americans," said Rev. Michael D. Place, president and CEO of the Catholic Health Assn. of the United States.

The assembly's initiative is likely to find a receptive audience in the American public, policy community and political system, several health policy analysts said.

Government statistics released in October showing that the number of uninsured Americans grew by another 1 million last year despite the booming economy rejuvenated calls in Washington for something to be done to address the problem.

With the number of uninsured people continuing to grow, "it was only a matter of time before the issue re-emerged on the radar screen," said Paul Fronstin, PhD, senior research associate with the Employee Benefit Research Institute.

In addition, the electorate has realized "that in a good business climate, the security of their health insurance isn't there," said Robert Blendon, ScD, health policy and political analysis professor at Harvard University. The public once again is beginning to think that the government should get involved, he said.

Indeed, for the first time since February 1995, polls show that health care issues (as well as education) top the list of Americans' concerns, said Humphrey Taylor, chairman of the Harris Poll. Although at about 19% the number of Americans concerned about health care coverage hasn't hit the 30% to 40% level reached during the debate over the Clinton plan, the numbers have bounced back from recent years, he said.

The managed care patient protection debate in Congress also has focused the nation's attention once again on health care, several policy analysts said. It has led many people and politicians to question why the spotlight was turned on helping people with insurance when millions don't have coverage, said Diane Rowland, ScD, executive vice president of the Kaiser Family Foundation.

The presidential election also will keep the focus on insurance access. Already, Democratic hopefuls former Sen. Bill Bradley and Vice President Al Gore are using differences in the scope and cost of their health care reform proposals as a way to differentiate their platforms.

Assembly participants vowed to make universal access an issue in the presidential race.

"We will ask every candidate: 'Is this a priority item for you and are you going to make a commitment to solve this problem?' " AMA President Thomas R. Reardon, MD, said.

Despite the growing interest in addressing the problem of the uninsured, the participating groups said they recognized that developing a solution would be difficult.

"We must bring other key groups and players into the fold," Dr. Reardon said, "including our political decisionmakers, knowing full well that as we work toward specifics there will be ... differences of opinions, but also recognizing that if we can keep our commitment to the effort we launch here, that we will move toward a solution that benefits all of us. Despite any disagreements, there is agreement that the status quo is unacceptable."

The fact that such a diverse assembly of interest groups has joined together to find common ground on the issue is significant, Dr. Blendon said.

One reason the Clinton plan failed was that the administration didn't get affected interest groups on board before developing the proposal, he said. Those groups then began fighting the plan and fighting each other.

"It's important to ... find group commonalties, and that might make it easier for people in politics to deal with this," Dr. Blendon said.

Assembly participants agreed that whatever solution they come up with, it likely will be multipronged, build on the successes of current, largely employer-sponsored health insurance systems and require partnership between the public and private sectors.

For example, it could include expanding Medicaid to help the near-poor and offering income-based tax subsidies to low-wage workers, said Richard L. Huber, chairman, president and CEO of Aetna Inc.

"There might be a number of solutions because this ... is a widely diverse group with subgroups, which have different problems," he said.

Outside analysts agreed that universal coverage will not come about in one fell swoop by one big program.

The nation is not going to embrace a single-payer system or an individual mandate to purchase insurance, Dr. Rowland predicted.

The solution "will require a multifaceted strategy, but one that is more global than the incremental steps we've seen so far," she said.

"People don't want a new government plan, but they want to see the government take steps to solve the problem," Dr. Blendon said.

The biggest obstacle will be the cost, analysts agreed. The public and politicians will not be willing to pay the billions it would take to cover the 44 million uninsured all at once, Dr. Blendon added.

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