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President's Column

ACP-ASIM advocates real coverage for those without—and with—insurance

From the February 2001 ACP-ASIM Observer, copyright 2001 by the American College of Physicians-American Society of Internal Medicine.

Over the past seven years, the U.S. economy enjoyed the longest sustained growth in prosperity in the nation's history. During this same time, however, the number of uninsured grew, from approximately 35 million in 1994 to 43 million today.

Almost a decade ago, before the issue appeared on the radar screens of many politicians, a far-sighted internist began working on the issue of universal access to care. This kind, gentle man was Nicholas Davies, MACP, my mentor and friend. Nick died in an airplane crash in 1991 on the eve of assuming Presidency of the College.

Then in 1999, ACP-ASIM President Whitney W. Addington, MACP, once again championed this cause. Dr. Addington is a passionate crusader for the underserved and continued the work that Dr. Davies and others in the College had begun.

During the last year, it has been my privilege to continue these efforts through the ACP-ASIM Decision 2000 campaign. The College launched the campaign to increase public awareness of the real health consequences of not having health insurance. To show its commitment, the College committed $1 million to the campaign.

The Decision 2000 campaign has helped educate tens of millions of Americans about the real health care problems faced by uninsured Americans. As a result, the issue of access to care gained prominence in the 2000 congressional and presidential campaigns, including particularly focused exchanges during the presidential debates.

ACP-ASIM has also developed core policy principles to serve as a roadmap to achieving access to affordable health insurance for all Americans.

Health effects

As internists, we have seen the results of a lack of health care for too many years. It is simply unacceptable that tens of millions of U.S. citizens must go without health insurance because they cannot afford it. Access to affordable health care should not be a luxury-it must be the right of all citizens.

The College's first report on this issue, "No Health Insurance: It's Enough to Make You Sick," examined more than 100 scientific studies and came to a simple conclusion: People without health insurance tend to live sicker and die younger.

The College's second report focused on the unmet health needs of America's Latino population, the nation's fastest growing minority group. While Latinos make up 12% of the population, they account for 25% of the uninsured.

A third report focusing on women and access will soon be released. It will discuss the disproportionate effect of the lack of health insurance on women.

In Chicago, Miami, and Austin, Texas, ACP-ASIM cosponsored (with the Commonwealth Fund and the National Hispanic Medical Association) symposia on the health consequences of access problems for uninsured Latinos. These symposia brought together community activists, public health advocates, physicians, and business and government leaders to learn more about access problems among Latinos—and to explore possible solutions.

ACP-ASIM placed advertisements in the Washington Post and Roll Call on the health consequences of being uninsured. We cosponsored similar ads with the American Academy of Family Physicians and the American Academy of Pediatrics in the National Journal's special daily report at the Democratic and Republican conventions.

The College also financed 30-second public education messages on CNN's "Inside Politics" and "Crossfire" programs for a two-week period last October, around the time of the presidential debates. These spots informed viewers that 80% of the uninsured come from working families, and that they are less likely to obtain preventive services (making them more likely to experience adverse health outcomes) because they are uninsured.

Education

The College understands that it is not enough to educate voters and policy-makers about the importance of access to affordable health insurance for all. We must also explain how to improve access to care.

Nevertheless, it will take a continued effort with support from other organizations to educate the public and policy-makers about the urgency of providing health insurance coverage to all Americans. ACP-ASIM remains firmly committed to this goal.

The College is also committed to correcting the problems faced by people who have coverage but who regularly fall victim to a managed care delivery system that has lost sight of patients' interests. It is not enough to have coverage: Americans need health coverage that provides care, not a flawed delivery system that harms our patients through denials, limitations and misguided physician incentives.

At a minimum, our patients and our members need a national patient bill of rights to ensure that no insurance company or managed care organization can interfere in the delivery of care. Those that do so must be legally accountable.

Both parties and the new president have called for bipartisan cooperation. There is no better measure by which to illustrate such cooperation than with the Norwood-Dingle patient bill of rights, which reflects the essence of bipartisan cooperation.

In fact, this bill has enough co-sponsors in the House from both sides of the aisle to ensure its passage there. Rep. Charles Norwood (R-Ga.), a dentist from my home state, should be commended for standing firm in his support of patients and physicians on this important issue.

In the coming year, the College will continue to work with other medical organizations toward the goal of a real patient bill of rights. You will hear more about that in the coming months.

I urge each of you to enlist the support of your patients and your congressional representatives in this effort. It is up to each of us to press our elected representatives on important issues like access to care and a patient bill of rights.

Together, we can help extend health care coverage to those without it and also help those with coverage to get the care they deserve.

Sandra Adamson Fryhofer, FACP

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