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Report calls for universal health cover for all US citizens
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     Health insurance cover should be extended to all American citizens, concludes a new report from the US Institute of Medicine.

    The institute’s sixth and final report on the impact of the lack of health insurance on health care calls on the president and Congress to "develop a strategy to achieve universal insurance coverage and to establish a firm schedule to reach this goal by 2010."

    The earlier reports detailed the consequences of the lack of health insurance for individuals, the stress it places on the healthcare system, and the costs to society. The reports are intended to inform a national debate on the issue during the forthcoming US presidential election.

    Since the institute began its work on the issue in 2000 the number of uninsured citizens in the United States has risen from 39.4 million to over 43 million as a result of population growth. This means that 17.2% of people under the age of 65 currently have no health insurance, and the report warns that this figure is likely to increase.

    The report highlights the many attempts to extend health insurance cover in the United States during the past century, pointing out that none of them has succeeded in achieving universal coverage. Further plans are in the pipeline, and the report sets out five guiding principles "by which the merits and limitations of proposed strategies can be assessed and compared," said Dr Mary Sue Coleman, president of the University of Michigan and coauthor of the report.

    These principles stipulate that coverage should be universal, continuous, affordable, and sustainable and that it should enhance health and wellbeing by promoting access to high quality, equitable, and patient centred care.

    "We can no longer afford to ignore this problem. We must find a way to cover the uninsured," comments coauthor Dr Arthur Kellerman, of the Department of Emergency Medicine at Emory University School of Medicine, Atlanta.

    The report is blunt about the difficulties of achieving the desired goal. The lack of political consensus has "hindered a reduction if not elimination of the problem of un-insurance," it says, and it recognises the need for cross party political and public support.

    The additional public funding needed is also likely to be a major hurdle, says the report. The United States already spends almost $3bn (¡ê1.6bn; €2.3bn) on health care, and the extent of waste and inefficiencies in the system have already provoked debate. But the institute maintains that reducing the administrative costs of the increased coverage will provide substantial savings that would offset any funding increases, not to mention the economic benefits from improved health and enhanced life expectancy.(Washington, DC Charles Ma)