Another pound of cure (caring for the uninsured and underinsured)

Article Abstract:

The 1991 theme issue of The Journal of the American Medical Association focused on health care for the uninsured and underinsured and addressed the need for improved access to health care for all Americans; however, it failed to adequately address the issues of preventing disease and disability and promoting good health. All Americans should be extended the fundamental right to have access to quality health care at a cost they can afford. There are some anomalies in our current system of health care; we willingly pay $2,000 a day for the care of a low-birth-weight baby, yet we do not pay for prenatal care, which costs about $500 per pregnancy and can reduce the incidence of premature births. We are now experiencing an epidemic of measles; this is a consequence of failure to provide immunizations. The remedial medical and educational services required to deal with the consequences of lead poisoning in children exceed $1 billion annually; medical insurance does not even cover the cost of screening children for lead toxicity, let alone the cost of remedial care. Government and private insurance companies may pay up to $50,000 per patient to treat breast cancer, yet the cost of a screening mammogram (about $75) is usually not covered despite evidence that mammographic screening saves lives. Only a small fraction of the money spent on health care this year will be spent on prevention of disease and disability and promotion of health. Recently Blue Cross and Blue Shield took a step in the right direction by offering periodic preventive care and screening as part of their basic coverage available to healthy adults. Senator Harkin believes that disease prevention and health promotion must be part of any significant health care reform. In the US Senate, he has introduced a legislative package called 'Prevention First'. This is a series of acts that would extend preventive medicine to many Americans, address the issues of lead poisoning and breast cancer screening and appropriately change the name of the Centers for Disease Control, our main disease prevention agency, to the Centers for Disease Prevention and Control. Many of the solutions put forth to deal with the issues of the uninsured and underinsured represent another pound of cure within a system of quick fixes and inadequate remedies. It is time to put prevention first; prevent disease and disability for everyone at home, in school and at work. (Consumer Summary produced by Reliance Medical Information, Inc.)

Innovations, Laws, regulations and rules, Political aspects, Medical screening, Health screening, Medical policy, Health policy, Preventive medicine, Medicine, Preventive

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Access to health care for the uninsured: the perspective of the American Academy of Family Physicians

Article Abstract:

In the United States today, over 37 million people (12 percent of the population) are not covered by any form of health insurance. Consequently, these individuals are unlikely to seek medical care until their health deteriorates significantly. Due to their inability to pay for needed medical services, they are more likely to generate bad debts or require charity, and they are more likely to die from complications arising from limited access to health care. The majority of the uninsured are poor and working-class people who are not covered by Medicaid (only about 40 percent of the population with incomes below the federal poverty level are covered by this program). The American Academy of Family Physicians (AAFP) has presented a prototype plan for restructuring the health insurance system which would, according to its analysis, significantly improve access to health care for low- and middle-income families, while sharing the economic burden more or less equally between the private and public sectors. The fundamental changes required by the AAFP plan would be a requirement that all employers (with more than a predetermined minimum number of employees) provide health coverage for their full-time employees, and Medicaid would be expanded to allow full coverage for individuals and families with incomes up to 100 percent of the federal poverty level. Persons with incomes between 100 and 200 percent of the poverty level would be given a buy-in opportunity with a sliding subsidy based on income. The cost of implementing this program is estimated to be $18.3 billion (exclusive of administrative costs). It would cover approximately 83 percent (26.7 million) of the adults and children who are currently without medical insurance. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Medical economics, Social policy, Ethical aspects, Health services administration, American Academy of Family Physicians

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