Institute of Medicine
January 14, 2004
Committee on the Consequences of Uninsurance
Insuring America’s Health: Principles and Recommendations
Principles to guide the extension of coverage
1. Health care coverage should be universal.
2. Health care coverage should be continuous.
3. Health care coverage should be affordable to individuals and families.
4. The health insurance strategy should be affordable and sustainable for society.
5. Health insurance should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable.
Using the principles
The Committee concludes that health insurance coverage for everyone in the United States requires major reform initiated as federal policy.
The Committee recommends that these principles be used to assess the merits of current proposals and to design future strategies for extending coverage to everyone.
To illustrate how the principles should be used to evaluate reform proposals, the Committee sketches four prototypes for major reform in a simplified format so that the main incentives are clear. It then assesses ach prototype against each of the principles, highlighting the model’s strengths and weaknesses.
The prototypes
1. Major public program extension and new tax credit
2. Employer mandate, premium subsidy, and individual mandate
3. Individual mandate and tax credit
4. Single payer
Each of the four prototypes satisfies the principles better than does the status quo. Each model does so through different mechanisms and realizes each principle to a different degree. The Committee does not recommend one approach over another.
The Committee recommends that the President and Congress develop a strategy to achieve universal coverage and to establish a firm and explicit schedule to reach this goal by 2010.
It is time for our nation to extend coverage to everyone.
http://books.nap.edu/books/0309091055/html/index.html
Comment: The Committee has provided a great service by demonstrating, in previous reports, the severe deficiencies in our system related to uninsurance, and now by providing an unqualified recommendation for universal coverage.
In the interest of objectivity, the Committee has not recommended a specific model of universal coverage, but the crucial importance of examining the specific impacts of each model is appropriately stressed. Table 5.2 in the report (page 150) does demonstrate that the single payer model is the most effective in ensuring continuous, universal coverage, and that the coverage would remain affordable for individuals and for society.
Single payer advocates will find much in this report to continue to fuel our passion for reform.