Published in the ACP Observer, May 1996, Volume 16, Number 5, Page 2:

"Just a few years ago, the United States and South Africa were the only developed countries whose citizens did not enjoy universal coverage. Since the end of apartheid, South Africa has made important strides to extend coverage to all its citizens. The United States appears to be going in the other direction.

The failure of major health reform efforts and the turn to corporate strategies to reduce health care expenditures have led to an increase in the number of uninsured Americans. Arguments that the marketplace will solve problems in the health care system assume that stemming costs will somehow lead to expanded coverage. In fact, the opposite has happened. As the marketplace increasingly focused on health care, the number of uninsured Americans has grown.

ACP issued an important policy paper during Annual Session last month, calling attention to the adverse consequences for the health of the uninsured, to the adverse implications for the rest of the health care system, and to the probability that this problem will worsen unless health policy changes significantly.

These are courageous statements in the current policy environment. Policy makers are focused on reducing government programs, deregulating industry, and enhancing states' power. Medicare and Medicaid cutbacks - not the problem of the uninsured - are the major health care topics in politics.

Why is that, if the problem is getting worse ? The likely explanation is that marketplace forces and deregulation cannot solve the problem.

As U.S. industry continues enormous layoffs, and businesses (including health care) succeed by "downsizing", the ranks of the uninsured swell. Most of these are working people and their families. Often, their new employers do not offer health insurance. In some industries, such as agriculture, about one-half of workers have no health insurance. If a company can find workers without offering insurance, it probably will not change its policies. Thus, the marketplace is not likely to solve the problem.

Nonetheless, politicians are not eager to suggest significantly different approaches, because most of them (i.e., raising taxes, regulating insurance companies) are politically unpopular.

But ignoring the problem won't make it go away. As more than $10 billion is siphoned out of health care every year to pay investors, public voices solemnly proclaim, "We can't afford universal coverage." Even the not-for-profit health systems, under increasing competitive pressure, are growing reluctant to accept indigent patients. The academic hospitals, under similar pressures, may not be able to continue their traditional safety net role. Thus, as the numbers of uninsured rise, their safety net shrinks.

The College's policy paper asserts that physicians have a moral responsibility to voice concern about the rising number of uninsured Americans. Even though it may not be politically popular, we must speak out on behalf of our patients and their families. Nothing is simple about health care reform, and costs must be prudently managed. But there are billions of dollars being lost from the system that might be used to cover the uninsured.

If every other developed country has had the moral will to confront this problem, the United States must too. ACP calls on the medical profession to raise its voice on behalf of basic health care for all."