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Universal health care sought

Panel of scholars wants all Americans covered by 2010

WASHINGTON -- The United States must find a way to provide health care coverage to all Americans by the year 2010, the National Academy of Sciences recommended yesterday.

Culminating the most detailed, authoritative examination of the pain and suffering caused by the uninsured in America, a scholarly committee of the academy's prestigious Institute of Medicine for the first time formally recommended that the United States guarantee health insurance for every citizen.

"The lack of health insurance for tens of millions of Americans has serious negative consequences and economic costs not only for the uninsured themselves but also for their families, the communities they live in, and the whole country," concluded the 16-member committee, composed of a diverse array of health policy specialists. "The situation is dire and expected to worsen. The Committee urges Congress and the Administration to act immediately to eliminate this longstanding problem."

The panel sidestepped recommending a specific approach for achieving the highly complex, politically volatile issue. Instead, the panel issued a "checklist" of five principles that it said should guide federal officials, politicians, and policy makers in tackling the problem -- and voters in assessing candidates.

"We're not saying that one plan is better than another. There may be a blend," said Mary Sue Coleman, president of the University of Michigan, Ann Arbor, who cochaired the panel, before the report was released in Washington. "Our point is not to say we know the right plan for the nation, but what we have done is provide the evidence for the nation that something must be done, and provide principles for achieving that goal."

With the economic uncertainty driving rising public concern about the issue, and a presidential contest underway, Coleman said she hoped the committee's uncharacteristically bold recommendation could become the tipping point for creating the national momentum necessary to finally accomplish the lofty, elusive goal.

"We're calling for action. We're calling for universal coverage by 2010," Coleman said. "There have been times in our history when we have galvanized ourselves to action. This may be one of those points in history. I certainly hope that the nation will be galvanized to act."

While some criticized the report for a lack of specificity and for not pressing for action sooner, overall it drew praise from across the political spectrum.

Stuart Butler of the conservative Heritage Foundation called it "pretty much on the mark," although he wondered what the committee meant by minimum coverage and how much any solution might cost.

Ron Pollack of liberal-leaning Families USA called the report "very significant" and said he hoped it would "catapult this issue to the top of the agenda." In a statement, Senator Edward M. Kennedy, Democrat of Massachusetts, said, the Institute of Medicine "has made it clear that the cost of continued inaction is unacceptable -- for individuals, for families, for communities, and for our nation. The Bush administration and the Republicans have shown themselves unwilling to act."

The report, however, drew a cool response from the Bush administration, which has proposed new tax credits to help the uninsured buy coverage. Health and Human Services Secretary Tommy G. Thompson said the proposal was "not realistic."

"I don't think there's anybody except for a couple of candidates running for president on the Democrat side [who] are talking about a universal health system," Thompson said earlier this week during a briefing with reporters. "I don't think it's in the cards -- I don't think administratively or legislatively it's feasible."

Most of the nine Democratic presidential candidates have offered ambitious plans for moving toward more universal coverage, especially for children and young adults, using combinations of expanded state and federal programs and new tax breaks for businesses and individuals to make private insurance more accessible. The price tags and number of people who would be covered vary from plan to plan, with Representative Richard A. Gephardt of Missouri offering the most comprehensive and costly plan, with a price tag topping $2 trillion over 10 years. Senators Joseph I. Lieberman of Connecticut and John Edwards of North Carolina have more modest proposals, with price tags closer to $700 billion, and former Vermont governor Howard Dean and retired Army General Wesley K. Clark of Arkansas are proposing plans with costs and coverage somewhere in between.

Two Democratic candidates -- Representative Dennis J. Kucinich of Ohio, and Al Sharpton of New York -- favor a single-payer health system, entirely funded by the government, of the sort that provides medical coverage in Canada. Former senator Carol Moseley Braun of Illinois, who plans to leave the race today according to reports by MSNBC and the Associated Press, had also favored such a plan.

All of the candidates say they would pay for some of the costs of their plans by repealing some or all of the tax cuts passed since Bush took office.

The Institute of Medicine report was sponsored by the Robert Wood Johnson Foundation, a private, nonprofit philanthropic foundation.

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