Universal Coverage – A Call for Action

NCHC Writer
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Michael M.E. Johns, M.D.
Executive Vice President for Health Affairs
Director, The Robert W. Woodruff Health Sciences Center Emory University
“Universal Coverage – A Call for Action”
National Coalition on Health Care Leadership Summit
The Carter Center, Atlanta, Georgia
January 26, 2000

Introduction to Open Forum for Discussion

At this point, after hearing from so many distinguished speakers, including our host, it is hard to find anything left unsaid about the ongoing crisis of the uninsured. I will say though that we at Emory, literally hundreds of our physicians, residents and students see this crisis everyday and confront daily the terrible human toll that this crisis extracts.

Georgia is now sixth in the nation in terms of percentage of the population with no insurance at all.

The largest numbers of these live in Fulton and DeKalb Counties – the same counties with the highest rates in the state of trauma, AIDS, tuberculosis, and many other high cost illnesses.

Between 1995 and 1998, the percentage of the population eligible for Medicaid dropped by 26 percent in Fulton and 23 percent in DeKalb.

Of patients seen by Emory physicians at Grady last year, for example, 43 percent had no insurance or resources to pay and 51 percent were covered by Medicare or Medicaid, both of which also continue to lower reimbursement for services.

And of course, the 1997 Balanced Budget Act is doing enormous damage to the financial health of Grady and Emory as well as other academic health centers and teaching hospitals.

Over the five year period of the bill Grady stands to lose some $55 million from this cause alone. Emory Hospital also expects to see revenues dwindle by $47 million, Crawford Long by $42 million because of BBA cuts.

Emory doctors provided an estimated $24 million of uncompensated care to Grady patients last year and more than $190 million in uncompensated care over the past decade.

Emory physicians also provide free care to Grady community projects and additional uncompensated care to County and State patients at other facilities, especially in highly complex services.

The lack of pharmaceutical benefits for both the insured and uninsured is a major problem. Especially for those afflicted with chronic illness. This costs more in the long run in unnecessary admissions etc.

There are many studies showing that the uninsured do not get the health care services they need or that are best for them, especially preventive and wellness programs that include regular check-ups and care counseling.


Georgia at a Glance:

Total 1997 Population: 7,481,000
Total 1994-95 Population: 7,138,000
Low-Income (below 100% of Poverty) Population (1994-95): 1,087,000
Percent Low-Income: 15.2%
Uninsured Population (nonelderly, 1994-95): 1,021,000
Percent Uninsured: 16.0%
Medicaid Enrollment (nonelderly, 1994-95): 829,000
Percent Medicaid: 13.0%
Medicaid Managed Care Enrollment (1996): 309,503
Percent of Medicaid Enrollment in Managed Care: 32%
Total Medicaid Spending (1995): $3,581,000,000
Federal Medicaid Assistance Percentage (FMAP, FY 1998) 60.8%

*From the Kaiser Foundation Commission on Medicaid and the Uninsured

All of this points me, as both a medical professional and as a citizen to the need for some sort of universal coverage that provides a basic benefits package that is available to all. And here it doesn’t matter what your ideology is. It is quite conceivable to have a health system that is a mix of public and private payors and providers.

Joe Martin, the dean at Harvard had an op-ed in the Boston Globe just last weekend that I agree with. We need an IS system that allows health professionals and patients to easily but confidentially share information and a basic benefits package. With information and a rational payment system, we could make extraordinary advances in public and population health. I guarantee it.

And I also agree wholeheartedly with a recent assessment by Uwe Reinhardt, the Princeton Economist, who argues persuasively, I think, that it is not economics or technical issues that prevent us from providing the proper health coverage and care to all Americans. The problem is simply parochialism, self-interest and what Reinhardt calls “The status Quo as Plan B.”

I think he is worth quoting here because there has rarely been a truer statement made about our health care dilemma. This is from a paper he delivered at a U.S. Chamber of Commerce sponsored Symposium, entitled, ” The Forgotten Health Care Crisis: Uninsured Americans.” Perhaps some here in the audience were in attendance.

He said the following, ” Over the years, hundreds and possibly even thousands of proposals have been crafted to extend insurance coverage to the uninsured. Every politically powerful interest group[ that derives income from the health care process now has on its shelf a ready-to-go proposal in this regard, which we might call “Plan A.” Much thought will have gone into Plan A. As far as the uninsured are concerned, it would certainly be better than the status quo.

Then he continues, “Any such interest group will countenance also competing proposals put forth by other organizations or by independent policy analysts, but only under one condition: that any such proposal does not under any imaginable scenario reduce the economic privilege that would otherwise be enjoyed by the interest group in question, under the status quo. If that requirement is not met, then the interest group will always prefer Plan B, which is the status quo.”

Now, has there ever been a truer statement about why we continue to be the only modern industrial nation not to ensure health care coverage for all of its citizens?

Well, I’ve said enough and now invite all of you to have your say – but I challenge you to provide a truer analysis of our lack of real progress on this fundamental issue.

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