Editorial Columns

Does Acadame Care about the Uninsured?

We in higher education pride ourselves on our ability to respond to the needs of society and on the enormous impact our institutions have on our nation. Yet, somehow, for all of our successes in tackling the problems plaguing society, we have overlooked the serious plight of a growing number of Americans, about 39 million at last count, who are uninsured and do not have adequate health care.

I am reminded of Thomas Jefferson's belief that education and health are the foundations of a citizenry able to sustain a democratic society. Although academe has tended to tiptoe around the dilemma of the uninsured, a new initiative sponsored by the Association of Academic Health Centers -- the Academics for Health Care Initiative -- seeks to remedy this historic indifference.

The uninsured are not who you might think they are -- in fact, most Americans not only underestimate the number of people who lack health insurance, but they incorrectly believe that most of the uninsured are unemployed. In fact, eight in 10 uninsured adults or children live in families in which at least one family member is working. The number one reason given for being uninsured is that insurance is too expensive. In a 2000 nationwide health survey by the Kaiser Family Foundation, 76 percent of respondents without health insurance said that buying insurance would require them to give up basic necessities such as food and rent.

Despite the fact that universities and the academic health centers they have spawned have not been bashful about pledging their loyalty to the well-being of children, youth and families, we still appear to view health care as the domain of health professionals -- territory where no one else dare need tread. Perhaps the complex, often controversial debate on health care access, fraught with tough choices and political overtones, has deterred us from speaking out about a problem that threatens the welfare of our nation.

The absence of health insurance for so many Americans, including 8.5 million children, should command our attention. The downward slide of the economy combined with the continuing rise in health care costs and increasing insurance premiums point to the probability that without intervention these numbers will swell to unheard of proportions. We can anticipate renewed public attention to the issue of health care access, even though years of national focus on the issue have yielded no substantial improvement. Should higher education enter the fray?

Insurance coverage is the key. Studies show that the uninsured experience reduced and delayed access to care. They are less likely to receive preventive care, suffer poorer medical outcomes when they do obtain care, and are four times as likely as insured patients to experience avoidable hospital stays for illnesses such as asthma, hypertension, and diabetes. Even after being released from the hospital, the uninsured do not have the means for critical follow-up care. Because of their inability to access health care, the uninsured fall victim to more life-threatening diseases. Diseases such as cancer are usually diagnosed at later stages when the condition is no longer curable. Uninsured individuals with chronic conditions and special health care needs are at a serious disadvantage.

In addition, self-imposed rationing among people who cannot afford to pay for the drugs required to treat their diseases is emerging as a tragic health issue. To put it bluntly, uninsured Americans tend to live less healthy lives and die earlier than those who are fortunate enough to be insured. The irony is that while our great research institutions continue to produce some of the best knowledge related to preventing and curing diseases and our teaching hospitals advance the practice of medicine in this country, millions have no effective way of accessing those life-saving developments.

The United States is the only developed nation without health insurance coverage for its citizens. Evidence shows that lack of health care coverage for such a large segment of the population has a detrimental impact on the nation as a whole. Not only is medical treatment for the uninsured often more expensive because of their delay in seeking care, the uninsured regularly use higher cost emergency room care, adding further expenses to the health care system that are passed on to the insured. A nation that does not help its disadvantaged population seek needed medical care is less productive, since those suffering from the burdens of illness are not able to contribute to their family or community. Since its founding, public higher education has espoused a goal of full and equal access for all to educational opportunities. Should we not view access to health care as equally compelling, and should we stand idly by as the gap between the insured and the uninsured continues to widen?

America's academic health centers historically have played a major role in ensuring health care services to the underserved. In fact, 44 percent of indigent care in this country comes from the 6 percent of teaching hospitals associated with universities.

What else can universities do?

First, university leaders can commit to working with the Association of Academic Health Centers (AHC) on its recently established Academics for Access to Health Care Initiative. The AHC, a non-profit organization representing more than 100 member institutions, has launched a sustained campaign called "Why Not Everyone?" that seeks to educate the public and policymakers about the importance of access to health care and the consequences of having a nation with so many of its people uninsured.

Universities and colleges can also:

• Develop their own programs to enhance education of internal and external constituencies about health care cost, access and quality issues;
• Educate students about health issues, including those of the uninsured. Student interest in research, health promotion and medical treatments can be tapped to support local and state educational efforts about access; and
• Focus on health promotion/disease prevention in the community and use the university's technological capabilities to raise awareness about the broad array of health issues.

With the AHC offering the necessary initial stimulus and infrastructure for all of academe to join in the ongoing struggle, I encourage others outside the health fields to join in support of this initiative.

Few issues so effectively undermine our nation's claim to being the land of opportunity than the lack of medical care for everyone.

Graham B. Spanier, president of The Pennsylvania State University, serves as co-chair of the Council of Presidents of the Association of Academic Health Centers.