Maryland's Uninsured Are Focus of 2004 Colman Lecture (web article)

America’s health insurance crisis must be resolved by a total makeover of our health system, said health advocate Jeff Singer during an April 14 talk at the Johns Hopkins Bloomberg School of Public Health.

“The Institute of Medicine says 18,000 deaths each year can be traced directly to a lack of health insurance,” said Singer, president and CEO of Health Care for the Homeless, Inc. “People who are poor are sick and have no insurance. The poor suffer a 50 percent higher risk of death, and this is not from bad diet, gun violence and so on—all those variables have been factored in. Poverty alone causes this difference. Health disparity—inequity—kills.”

Mr. Singer, speaking at the 2004 J. Douglas Colman Lecture entitled “Health Care for the Uninsured: Possible Solutions to a Serious Public Health Problem,” noted that for 40 years we've been trying to fix the health care system incrementally. “It hasn't worked. The only solution is to make sure everyone is insured. And to be affordable, any new system must have parity, must have a prevention component, must eliminate disparities and  maximize choice and reduce paperwork.”

Alfred W. Redmer Jr., commissioner of the Maryland Insurance Administration and an insurance broker himself for twenty years, believes that most Marylanders are in fact insured “one way or another,” since even the poor have their medical costs absorbed by the health care system.

More to the point, Mr. Redner said, is to ask why people do not buy health insurance for themselves. He believes that the determining factor is most often the cost of insurance, which is based on three factors: the cost of delivering the health care itself, the administrative expenses such as enrolling and billing customers; and the profit margin. He said that health care costs (and so insurance costs) are going up not because CEOs' salaries are rising but because the costs of health care delivery—new technology and the use of that technology, as well as the increased costs of prescription drugs—are increasing.

Barbara McLean, executive director of the Maryland Health Care Commission (MHCC), presented the results of a study of Maryland's uninsured population, which her agency carried out with the help of two researchers from the School, Laura Morlock, PhD, and Hugh Waters, PhD. “These results,” she said, “will be used to help policy makers decide how to expand health coverage in Maryland.”

Among the study's findings

• 690,000 people, or 12.8 percent of the population, are without medical insurance in Maryland;
• the majority of uninsured are either working or are part of a family where someone is working;
• 38 percent of uninsured come from households with incomes above $55,000.

For the study, Dr. Waters, assistant professor, International Health, estimated that carrying its many uninsured people costs the state between $2.4 billion and $3.7 billion a year.

The J. Douglas Colman Lecture is delivered each year at the Johns Hopkins Bloomberg School of Public Health, as part of the General Preventive Medicine Residency Grand Rounds. The Colman Lecture honors the advances Mr. Colman marshaled in Maryland's ability to provide its citizens with cost-effective, high-quality care.

The lectureship was established after Mr. Colman's death in 1974 by longtime friend Dr. Russell Nelson, president emeritus of the Johns Hopkins Hospital. Dr. Nelson delivered the first lecture that year. In 1990, the Department of Health Policy and Management agreed that a wider audience, including policymakers, media, educators, students and laymen, could benefit from the Colman lecture.

The Johns Hopkins General Preventive Medicine Residency trains physicians as preventive medicine specialists and prepares them for leadership positions in government, academia and clinical medicine.--Rod Graham