May 12, 2006

Panel probes states’ role in covering nation’s uninsured

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On hand to discuss health insurance coverage in the United States were, from left, John Seigenthaler, founder of the Vanderbilt First Amendment Center and former editor and publisher of the Tennessean, John Sergent, M.D., Robert Miller, M.D., and Patricia Temple, M.D.
Photo by Anne Rayner

Panel probes states’ role in covering nation’s uninsured

Should the states solve the problem of the nearly 46 million Americans who do not have health insurance?

That was the question posed to a panel of experts at Vanderbilt University Medical Center Thursday during “Cover the Uninsured Week,” sponsored in part by the Robert Wood Johnson Foundation.

“There's money in the system right now,” said Patricia Temple, M.D., M.P.H., professor of Pediatrics, who organized the forum. “Where is the will to redistribute it?”

In the absence of a federal response, Temple noted that several states, including Tennessee and Massachusetts, continue to try to find solutions, but John Sergent, M.D., professor of Medicine, said, “This is not a state issue.”

When Tennessee's Medicaid reform plan, TennCare, was launched in 1994, “Memphis was suddenly inundated by people coming from Arkansas and Mississippi and other places,” he said.

Sergent, vice chairman for education in the Department of Medicine, said he does not support “socialized medicine,” where the government owns and operates the health care system, but does favor some form of government-provided national health insurance.

Many people assume the current “polyglot” system of private plans is more cost-efficient than a government plan. Not so, said Sergent, noting that the United States ranks relatively low among Western countries in life expectancy and infant mortality.

Robert Miller, M.D., medical director of the Shade Tree Clinic in East Nashville, which provides free care to the medically underserved, argued that health care is this nation's 21st Century civil rights issue.

He noted that heart and kidney disease and several forms of cancer are more likely to be detected at advanced stages among the uninsured compared to those with health insurance. An estimated 18,000 Americans die each year “because they don't have access to health care,” Miller said.

John Seigenthaler, former editor, publisher and CEO of The Tennessean and founder of the First Amendment Center at Vanderbilt, agreed that citizens should be guaranteed access to health care.

However, “the profit aspect of providing health care really poses substantial barriers to those who would have health care declared a civil right,” he cautioned.

Sergent said he also was bothered by the profit motive in health care, adding that he believes it is part of the physician's obligation to advocate for the uninsured.

“There was a saying during the civil rights movement, 'If you're not for us, you're against us,'” Sergent said. “I think the same is true here. If you're not for some form of national health insurance, then what you're for is a system that allows people to not get adequate care.”