IN A RECENT editorial in the ARCHIVES,1
I discussed the good, the bad, and the ugly aspects of health care in
America. I described as "ugly" the fact that at least 43 million Americans
lack health insurance, and as a result lack access to optimal health care.
I compared our health care system to other industrial nations where all
citizens have health insurance.
As I began to receive letters in response to my editorial, one question
appeared in almost every letter: what do you suggest that we do about it?
A very good question! It is far easier to find problems than it is to
solve them. It is my opinion that we can achieve near-universal health
care coverage for all Americans.
First, we should increase the provision of employer-provided health
insurance to all working Americans since 50% to 60% of uninsured Americans
work full-time or are the dependents of a full-time worker.2
This would dramatically decrease the number of uninsured. Second,
government (federal or state) should provide health insurance by Medicare
or Medicaid to those who do not have employer-provided health
insurance.
Sounds easy! But, how? As a noneconomist I would be hard pressed to
prepare a detailed plan of what it would take to accomplish these goals.
Nevertheless, I was determined to try. Fortunately, I attended the annual
meeting of the Association of Academic Health Centers on October 5, 2000,
in Tucson, Ariz. The keynote speaker was Karen Davis, PhD, president of
The Commonwealth Fund and a nationally recognized health economist. Prior
to assuming leadership of The Commonwealth Fund, Dr Davis served as
chairman of the Department of Health Policy and Management at Johns
Hopkins School of Hygiene and Public Health, Baltimore, Md. She had
previously spent many years as an economist at the Brookings Institute,
Washington, DC, and served as deputy assistant secretary for Health Policy
in the Department of Health and Human Services from 1977 to 1980.
Dr Davis' presentation, "A 2020 Vision for American Health Care,"
carefully and explicitly described how we could extend health care
insurance to the vast majority of uninsured Americans.3
She detailed how we could increase the number of Americans receiving
health insurance from their employer, Medicaid, and Medicare. It is the
first feasible plan for achieving near-universal health care insurance
that I have seen. Her plan would provide health care coverage to 37 to 43
million of the currently uninsured. She addresses the issue of the
additional costs of expanding health care coverage. She points out that a
very significant portion (as much as 45%) of the federal budget surplus
came from Medicare Balanced Budget Act savings and Medicaid savings from
welfare reform. Given the source of the federal budget surplus, it is
appropriate that some of it should be used to expand health care coverage
for uninsured Americans. It is, of course, unlikely that her plan will be
rapidly adopted, as is, by our government leaders or by the American
people. However, I believe that her plan is a valuable blueprint of how we
can approach the solution to this critical defect in our current health
care system.
With Dr Davis' permission and the permission of the Association of
Academic Health Centers, her plan, "A 2020 Vision for American Health
Care," is being published as the lead article in this issue of the
ARCHIVES.
As the primary providers of health care in the United States, your
response to her plan and your suggestions on how to modify or improve it
will be of great interest to Dr Davis and to the readers of the ARCHIVES.
We look forward to your responses!
