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The Issues
Students for a National Health Plan University of Iowa

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The number of people in the United States without access to health care is staggering. A September 2000 report by the U.S. Census Bureau highlights that 42.6 million Americans15.5 percent of the national populationlacked public or private health care coverage in 1999. The Census report also notes that despite Medicaid, the federal-state health care program for poor, disabled, and elderly people, nearly one-third of all poor people in the nation have no health care. This group includes many housed and homeless adults without accompanying children and working poor families. Over 55 percent of people experiencing homelessness have neither public nor private health care, according to a November 1999 study by the federal Interagency Council on the Homeless. Many Health Care for the Homeless (HCH) projects report that as many as 80 percent of their patients are uninsured.

Access to comprehensive health care is seriously compromised by the lack of a national health care system. While a crucial network of community-based providers including HCH projects, health centers, free clinics, and public hospitalshas emerged to provide basic care to uninsured people these providers serve less than one-sixth of those without health insurance.

The lack of universal health care endangers the public health. Untreated health conditions, particularly infectious and communicable diseases such as tuberculosis and HIV infection, quickly escalate from personal trials to become costly and deadly public health emergencies.

Finally, absence of a universal health care system increases the cost of health care for every American. First, because uninsured people often lack access to low-cost preventive and early intervention services, they go without care until easily treatable medical conditions become urgent medical emergencies. These uninsured individuals frequently seek uncompensatedand expensivecare in hospital emergency rooms, increasing the cost of health care for everyone. Second, the existence of multiple health insurers requires health care providers to incur enormous administrative expenses, requiring expensive billing departments and wasteful paperwork.

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