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Ann Thorac Surg 2000;70:354-355
© 2000 The Society of Thoracic Surgeons

Editorial

A call to leadership: project access—helping the uninsured community by community1

Paul N. Uhlig, MD, MPAa,b,c,d

a Section of Cardiothoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Jersey, USA
b Concord Hospital, Concord, New Hampshire, USA
c Department of Surgery, Dartmouth Medical School, Hanover, New Hampshire, USA
d Department of Family and Community Medicine and Department of Preventive Medicine, University of Kansas School of Medicine, Wichita, Kansas, USA

Address correspondence to Dr Uhlig, Memorial Building, Suite 103, 246 Pleasant St, Concord, NH03301
e-mail: paul.n.uhlig@dartmouth.edu

Health care in the United States exists presently in a state of suspended transformation. A strong economy and widespread public resistance to managed care have temporarily stalled powerful forces of change that have swept across the health care landscape for much of the past decade. We stand cautiously with our patients at the threshold of whatever is left of our former institutions and peer out, testing what is still standing and wondering whether the fury has indeed spent itself or if, in fact, the worst is yet to come. Undecided, we resume our work—not quite as before but familiar enough to be comfortable. All the while we watch and wait: for new ideas, for a renewed sense of direction, for signs of what will happen next.

The most foreboding sign, stark in clarity and unambiguous in significance, is the rising number of people without health insurance in the United States. Despite unprecedented economic prosperity, this number continues to increase at a rate of nearly a million new persons each year. Recent estimates suggest that more than 44 million Americans, nearly 1 in 6, do not have health insurance. The majority of the uninsured are employed, often at more than one job, but do not have affordable health insurance benefits. As their number grows, the reality of the lack of insurance hits closer and closer to home. Many of us have neighbors, friends, and even family members without health insurance, and we wonder how they will cope with the financial realities of serious illness.

We know from our own practices that, eventually, uninsured patients receive care. However, this care often comes late in the course of illness when the likelihood of complications is much greater and the cost, much higher. Beyond the personal consequences for the individuals involved, the growing burden . . . [Full Text of this Article]






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