Opinion

Let's move from awareness to action on the uninsured

A message to all physicians from AMA President Nancy H. Nielsen, MD, PhD.

By Nancy H. Nielsen, MD, PhDis an internist from Buffalo, N.Y. She was AMA president during 2008-09. Posted July 21, 2008.

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A few months ago, I was preparing to speak to the Economic Club of Florida, and as often happens while on the road, I met a woman who wanted to tell me her story. She was the general manager of the hotel where I was staying. She told me that her current employer covered all the costs of health care for all employees.

However, her previous employer didn't offer health insurance, so she purchased an individual health policy for six months as she prepared to relocate to Florida. The transition took a little longer, so she renewed the policy for another six months. One week later, she found a breast lump.

The insurance company refused to pay because it said her diagnosis stemmed from a preexisting condition. This was a woman who had a normal mammogram one year before and a normal breast exam three months prior to that. When I met her, more than four years later, she was paying off the last $5,000 of the $50,000 bill for breast cancer treatment.

Every physician reading this column likely has a similar story he or she can tell. I hope you will.

This is a woman who did everything right. She embodies the type of personal responsibility that the AMA cheers and government trumpets. She personifies the informed consumer who gets preventive check-ups and follows guidelines for tests such as a mammogram and breast self-exam.

Stories like hers literally rip the "care" out of health care. She did everything right, and the system failed her, leaving her to work herself to the bone to drag herself out.

Hers is a story of being let down by an insurer who denied coverage when it was "inconvenient." We must continue the effort to reform the health care marketplace to protect individuals like her.

But what about the nation's 47 million uninsured -- most of whom look at a system that is simply unaffordable. Or the nation's 25 million underinsured who face a continual choice -- purchase insufficient care or go without.

When I speak at audiences large and small, I ask for a simple show of hands: "How many of you know someone in your family or among your friends who is or has been uninsured?" I typically see three out of four people raise their hands. It is time to do more than tell stories.

We know the problem of the uninsured too well. The AMA Voice for the Uninsured campaign gives voice to the uninsured and raises awareness about the problem.

As I enter my year as AMA president, I am proud to take the reins of this important campaign as it enters a critical phase -- moving from awareness of the problem to building awareness of how to solve it.

In my year as president, I will use all of the power of the office, and of the AMA, to let the nation know we must cover America's uninsured, and the AMA has a plan to do just that. The main elements of the AMA plan:

  • Provide all Americans with the means to buy health care coverage.
  • Give individuals choices to select the appropriate coverage for themselves and their families.
  • Promote market reforms that enable this new approach.

The AMA proposal to cover the uninsured and expand choice uses an approach advocated by growing numbers of scholars and policymakers. The strategy is to pinpoint and address fundamental flaws in how people obtain and pay for health insurance in the United States -- flaws that limit the availability and affordability of coverage, especially for those with low earnings or no employee health benefits.

Dramatic improvement is possible. We can make better use of existing government resources devoted to health care and health care coverage, including the billions of dollars spent subsidizing employment-based private insurance. These resources should be drawn upon to, in essence, give people money to pay for a health plan of their choosing.

The AMA proposal would expand health insurance coverage and improve fairness by shifting government spending toward those most likely to be uninsured, i.e. people with lower incomes. It would also reduce the hidden bias favoring employment-based coverage, which provides special employee tax breaks for insurance obtained through an employer.

Currently, people who do not get their insurance from their employer do not get the tax break. Under the AMA proposal, they would. And employees dissatisfied with their employers' health plan offerings could choose to buy insurance elsewhere and still be eligible for assistance.

The AMA believes that health insurance market regulations should be reformed to establish fair "rules of the game" that protect vulnerable populations without unduly driving up premiums for the rest of the population. Regulations also should foster market experimentation to find the most attractive combinations of plan benefits, cost-sharing and premiums.

In short, there is a role for government in financing and regulating health insurance coverage. And health plans and health care services would be provided through private markets -- as they are currently.

The AMA proposal gives patients more control over our nation's health care dollars. The AMA proposal is pragmatic and permits flexible implementation. It increases affordability and choice. It reflects social values and traditions, such as assistance based on need, freedom of choice, market innovation and fairness.

In the coming months, I will be on the road in dozens of cities -- talking with physicians, medical students, policymakers and candidates across the political spectrum about the benefits of the AMA plan.

I will be clear in saying that we must work together to build a bridge with the goals of coverage and choice, combined with care and compassion.

We must work together because we cannot allow the problem of the uninsured to grow. We must build a bridge that prevents men, women and children from falling into the chasm.

The AMA has helped make voters and the candidates more aware of the issue, and now, both candidates have outlined their plans to cover America's uninsured. It's up to us -- America's physicians -- to hold them to their promises.

The AMA plan is a uniquely American solution that will help all Americans. It is the right care at the right time in the right place. Join me in urging the candidates to join us -- to work with us on a plan to cover America's uninsured.

Nancy H. Nielsen, MD, PhD is an internist from Buffalo, N.Y. She was AMA president during 2008-09.

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