HFMA VIEWS

Robert Fromberg
Editor in Chief, HFMA

The Commonwealth Fund just released a new study showing that a significant number of working, middle-income Americans lack health insurance and that the uninsured receive "inefficient" health care. 

What this reminds us about how the uninsured affect hospitals. This study vividly shows that hospitals are challenged not just by needing to provide uncompensated care, but by the fact that patients without insurance tend to be sicker because of their lack of routine health care, and that getting information about their health and health care is difficult.

Haven't I read this study before? We're faced with so many studies about the uninsured. As an experiment, I just did a Google search on the words "changing face uninsured" and sure enough the first hit was a 1996 study by the state of Connecticut that said the number of working families without health insurance was rising.

When do we reach the point when action is politically palatable? I saw David Gergen on TV last night talking about the history of the nation's efforts to enact energy reform. (By the way, Gergen is speaking at HFMA's annual conference this year.) He said when he was in the Nixon administration he was writing position papers about energy independence. He said maybe, just maybe, the confluence of a terror threat, high gas prices, and environmental concerns could bring us to the point at which the political will will be present to bring about energy reform. This study makes me wonder when we will reach that point with healthcare reform. The Nixon administration--during the height of Watergate--proposed healthcare reform that in many ways resembled the Clinton administration's proposals. (I once said that to Dick Clarke, who replied, "Nixon? How about Truman?") This problem has been with us for years, and reform proposals have been floated for years. What factors will make action inevitable? This study suggests that the middle class is more than ever affected by problems with health insurance coverage. We would like to think that the nation's concerns would be triggered if any group--lower class, middle class, or upper class--is afflicted by a serious and systemic problem such as this, but perhaps a rising awareness of the middle class's involvement will trigger political action.

Breakfast is over--time to head to the office and find out what wiser minds than mine think about all this.