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ACP-ASIM Pressroom
EMBARGOED FOR RELEASE UNTIL 5 P.M., EDT, MONDAY, APRIL 19, 1999 CONTACT: Susan Anderson, 215-351-2653 or 800-523-1546, ext. 2653

Philadelphia Physicians Look at Universal Access to Health Care



PHILADELPHIA—(April 20, 1999) Two pieces in the April 20, 1999, Annals of Internal Medicine focus on the status of access to health care in the U.S.

"Good clinically managed care can improve health for years to come," says Donald W. Light, PhD, in a perspective piece, "Good Managed Care Needs Universal Health Insurance." But good managed care requires four elements of stability, most importantly "coverage that does not change or evaporate."

"Pernicious managed care" saves money by limiting access to specialists, tests and procedures; underpaying providers or rewarding them for doing less; stalling or refusing to pay bills for services, and discouraging patients with serious medical problems. These tactics grow out of unstable, risk-rated and changing coverage, Light says.

The author, a senior faculty fellow at the Center for Bio-ethics at the University of Pennsylvania Health System in Philadelphia, contrasts trends in U.S. health care costs and coverage with other industrialized nations. Patching up the current U.S. voluntary insurance system with patients' bills of rights or niche coverage for special groups will increase overall cost and further cut coverage, Light says. A universal system need not have to have a "single payer"; many countries use more than one insurance pool or company and even private practitioners. But "a universal system is critical to large-scale savings."

Two other physicians pose a solution to the problems of the current U.S. health care system: a Constitutional amendment guaranteeing equal access to basic and essential health care.

Authors Frank Davidoff, MD, editor of Annals of Internal Medicine, and Robert D. Reinecke, MD, Professor of Ophthalmology at Jefferson Medical College, note that Americans have a Constitutional right to assistance of legal counsel but not to assistance of medical practitioners. They say that a Constitutional amendment would necessitate that all with a stake in U.S. health care agree on the meaning of basic and essential health care and then determine how to make that level of care accessible to everyone.

Drs. Davidoff and Reinecke note that the proposed amendment doesn't say how a system of equal access would be organized and financed although the federal government need not be directly involved in providing health care. The government does not provide rides to the polls although the right to vote is guaranteed by the Constitution.

The editorial writers don't believe it would be easy to pass such an amendment, but they feel the debate might highlight the fact that the U.S. already rations health care arbitrarily and capriciously. "There has to be a better way," the doctors say.
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For a copy of the article, "Good Managed Care Needs Universal Health Insurance," (p. 685) and the editorial, "The 28th Amendment," (p. 692) in the April 20, 1999, issue of Annals of Internal Medicine, please call (215) 351-2653 or (800) 523-1546, ext. 2653. Full text will be available on Tuesday, April 20, 1999, on Internet at http://www.acponline.org.

To reach Dr. Light, please call Rosann Thompson, University of Pennsylvania Health System, Office of Public Affairs (215) 662-2560.

To reach Dr. Davidoff, please call the ACP-ASIM Communications Dept. (215) 351-2653 or (800) 523-1546, ext. 2653.

To reach Dr. Reinecke (pronounced RINE-ick) please call (215) 928-3149.

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