November 2001 • POST-ASSEMBLY EDITION
Health coverage for all -- it can happen, and here's how
BY JANE STOEVER
"For the $600 tax refund many of us just got, we could have made sure all Americans got covered for basic health care," says Richard Roberts, M.D., J.D. The AAFP Congress of Delegates adopted a sweeping proposal, "Assuring Health Care Coverage for All," during the delegates' meeting Oct. 1 3 in Atlanta.
The plan would build from public and private funding and would cover everyone in the United States, including undocumented aliens.
(Then) AAFP President Richard Roberts, M.D., J.D., of Madison, Wis., countered the notion that the current health care system is almost completely a private instead of public system. He said, "Over 45 percent of our health care spending now is by the government. Do you want to eliminate Medicare? Medicaid? Military coverage? Veterans' health care?"
Providing the benefits under the plan would cost an estimated $52.8 billion more than current health spending. "For the $600 tax refund many of us just got in the mail, we could have made sure all Americans got covered for basic health care," said Roberts at a town hall meeting.
"We have our nation's defense provided through taxes. Education K through 12 is assured," said (then) AAFP Board Chair Bruce Bagley, M.D., of Albany, N.Y. "Coming after all the rest of the developed countries, it's about time for this society to say all its citizens should have access to health care."
After extended debate at the town hall meeting and during the Congress, the delegates adopted the proposal 72 50.
ELEMENTS OF THE PLAN
Under the plan, all U.S. residents would receive basic benefits, some with no copay (such as maternity care and periodic evaluations) and some outpatient services with a 20 percent copay (such as office visits and ER services). The plan would protect people from extraordinary costs by capping out-of-pocket expenses.
The plan retains the current insurance market; requires a national tax, such as a sales tax, value-added tax, payroll tax, or tobacco or alcohol tax; and calls for Congress to pass a law assuring basic health care for all.
A 1999 2000 AAFP task force wrote the forerunner of the plan. Last year, delegates called for widespread dissemination of the plan to seek reactions to it. Some 1,200 responses later -- from individual FPs, chapters and other groups -- the Board revised the plan and asked for its adoption.
Delegate Daniel Derksen, M.D., of Albuquerque, N.M., said, "For a 5 percent increase in cost, you get 17 percent of the people insured," referring to the more than 40 million uninsured Americans. "All of us see patients who are uninsured. Most of us see from 10 to 20 cents on the dollar for these people. This plan might help us."
CHALLENGES AHEAD
Some delegates zeroed in on the difficulties of getting the plan into the public arena and to the U.S. Congress.
Joseph Leming, M.D., of Colonial Heights, Va., the Virginia AFP
president, said the groups the Academy would need to do battle with were the ones to make alliances with before going to the U.S. Congress: the American Hospital Association, the U.S. Chamber of Commerce, the Farm Bureau.AAFP Past President Neil Brooks, M.D., of Vernon, Conn., said he spoke for universal health care but not the proposal. "I rise with a heavy heart to oppose this plan," said Brooks. "What we propose now comes at a cost that's not affordable, and it puts us in opposition to others in medicine at a time when we're trying to promote unity."
Some delegates feared members might misunderstand the plan. "Back home, perception is reality," said Jeffrey Akerson, M.D., of Sidney, Neb. "They'll see the headlines. The plan will be interpreted by the silent majority as socialized medicine, an intervention into their practices."
Akerson and many others advocated filing the report that contains the plan and continuing to use the report and embrace its principles.
Instead, delegates adopted the plan "with reservation," urging the Board to build consensus on the document among AAFP members.
The delegates earned thanks from AAFP Past President Lanny Copeland, M.D., of Frisco, Texas, chair of the 1999 2000 task force. "As family physicians, we're rebels, standard bearers," said Copeland. "The uninsured may be poor. They may be my son. They may be your brother. They may be illegal aliens. Because you adopted this plan, we'll be stronger in this country, and we'll serve our patients the best we know how."
The Academy will communicate the plan to members and dialogue with them and other groups about the plan.
After the delegates voted, Roberts said he'd been quiet during the lengthy debate on the floor of the Congress. "I was listening," said Roberts. "That's what we on the Board will continue to do -- listen to you, listen to our members. You've given us a direction, and we will follow it."
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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