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Physician groups unite for universal coverage

From the July/August 1999 ACP-ASIM Observer, copyright © 1999 by the American College of Physicians-American Society of Internal Medicine.

ACP-ASIM is working with six other major medical associations to make universal coverage a key issue in next year's presidential and congressional elections.

At a Washington press conference in late June, the Physicians' Work Group on Universal Coverage, which is chaired by College President Whitney W. Addington, FACP, announced a campaign to move the plight of the uninsured to the forefront of the national political agenda. There are currently 43 million Americans with no health insurance, a figure that analysts say could reach 48 million by 2004 if no action is taken.

"The 2000 election gives us the opportunity to promote universal coverage as an issue, and the booming economy gives us the means to turn this wish into a reality," said Dr. Addington, who was the press conference's headline speaker. "There is no reason to delay any longer."

In a statement, Dr. Addington announced that the ACP-ASIM Board of Regents will consider a plan this month to devote $1 million of College funds to promote the issue of universal coverage during the upcoming elections. That money would support educational efforts; paid advertising for public affairs campaigns; polls, studies and conferences; and grassroots efforts to help mobilize College chapters and patients to convince candidates to take a stand on universal coverage.

According to Dr. Addington, the coalition's other medical societies—the AMA, the American Academy of Family Physicians (AAFP), the American Academy of Pedi-atrics, the American College of Emergency Physicians, the American College of Obstetricians and Gynecologists, and the American College of Surgeons—will also contribute financial and organizational resources.

Guiding principles

In addition to providing funding, coalition members have agreed on the following three key concepts:

  • All Americans must have health care coverage.
  • That coverage should offer quality benefits.
  • Medical necessity should be based on generally accepted standards of medical practice that are supported by outcomes-based evidence.

While several of the coalition's member groups have in the past suggested different ways to solve the problem of the uninsured—the College unveiled a tax credit proposal in April, for example—they are united in challenging political leaders to pledge their support for universal coverage.

The coalition's leaders are hoping that their show of unity will help kick start interest in the problem of the uninsured. Since the demise of the Clinton health plan, policy-makers have shied away from comprehensive plans that address the lack of coverage.

"The way it looks now, no candidate may be willing to make the status of health insurance availability to Americans a major part of their agenda," said Robert Graham, MD, AAFP executive vice president. While there have been some recent efforts to extend coverage to children and to craft a patients' bill of rights, he said that the country appears to be "losing ground" when it comes to giving everyone basic health care benefits.

Preparing for elections

While organizers said it was purely coincidental that the coalition held its inaugural press conference on the same day that presidential contenders were arriving in Iowa, the timing may be a good indication of how the coalition plans to operate. Robert B. Doherty, the College's Senior Vice President for Governmental Affairs and Public Policy, emphasized that the upcoming presidential race was a critical factor in the formation of the coalition and will be a key target of its national advocacy efforts.

"Decisions about what issues will be top-tier issues in the presidential and congressional campaigns are being made right now," Mr. Doherty said. "We are trying to influence the candidacies of both parties, particularly on the presidential level."

He was also quick to point out that the June press conference was not a "one-shot deal" held simply to highlight the problems of the uninsured, but the start of an 18-month-long campaign which will include subsequent press events in states with key presidential and congressional primaries.

Mr. Doherty also noted that recent calls for universal coverage by other health care organizations—the Catholic Health Association called for universal coverage in May—are a sign that access to care is becoming a focal point of health care stakeholders. "But there's a lag," he said. "The stakeholders are ahead of the policy-makers."

Coalition leaders are hopeful that with their influence they can bring politics—and even others in health care—up to speed. In a telephone interview, Dr. Addington acknowledged that some physicians still tend to think that the lack of health care coverage merely translates into longer waiting times at emergency rooms. He added, however, that many more physicians now recognize that the growing number of the uninsured represents a public health disaster.

"Cutting across all socioeconomic status indicators, your outcomes are worse if you're uninsured," said Dr. Addington, who likened the effects of the lack of insurance to a lack of vaccinations or the impact of drug abuse. "Every physician has patients who don't seek care until it's very late or who don't fill prescriptions or follow recommendations, because they can't afford to.

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