In the emotionally charged debate over national health care reform one key point seems to get lost. That is that if we do nothing to improve access to health care for all, ultimately even Americans who have health insurance and enjoy full access to leading medical care will be at risk.
As it stands, 47 million Americans have no insurance. Another 25 million are considered "underinsured." Many of those individuals don't realize the inadequacy of their coverage until they actually get sick and need care or hospitalization.
When disaster strikes -- a cancer diagnosis, a major injury or other serious condition -- inadequate health insurance can mean financial ruin.
In the seven days after you read this, medical bills will force another 17,000 American families to file for bankruptcy; most of those have health insurance, but it doesn't cover their medical bills.
A lack of health insurance also translates to higher death rates.
Uninsurance can be blamed for an estimated 20,000 deaths in the U.S every year, four times as many Americans as have been killed in the wars in Iraq and Afghanistan over the past seven years.
In this period of economic instability and mounting job losses, more and more people are joining these ranks. One recent analysis predicted that each 1 percentage point increase in unemployment will lead to 1.1 million more adults without health insurance.
In some communities, uninsured individuals are lucky to have access to county or community clinics that offer free or low-cost care.
But more and more, those clinics too are closing under the weight of debt, forcing people in need to hospital emergency departments. And when hospitals go without reimbursement for their care, they can be forced to close, too.
That means that if you suffer chest pain in the middle of the night, you may not have access to the immediate care you need to save your life. And your health insurance is not a key that opens a closed hospital.
It may be tempting for people who have Medicare coverage to oppose health care reform. After all, some people say coverage for all may jeopardize your safety net.
But those who do this are mistaken; unless we move ahead to fix a broken system, Medicare will become insolvent within five to seven years, adding to the legions of Americans without coverage.
Nowhere is health care access a greater problem than in California's great Central Valley, where in some areas, one in every four people has no health insurance -- and correspondingly higher rates of disease and disability.
According to the Institute of Medicine, people covered by health insurance get more and better care for illnesses and injuries that disproportionately affect the Valley such as diabetes, heart disease, kidney failure and mental illness and traumatic injuries such as those caused by motor vehicle accidents.
When the Bush administration enacted a stimulus package that provided $600 tax rebates, the rationale was that it would help struggling families and ultimately spur economic recovery.
Consider the economic lift to Americans who, provided health coverage and preventive care, could stay in their jobs and earn a living. It wouldn't take long before those Americans contributed $600 each to our economy, not to mention the savings when unemployment benefits aren't needed.
Simply put, it makes no social or financial sense not to have universal access to health care.
We count on government to look after the well being of America. That is why the U.S. has spent $1 trillion on the Iraq war and its aftermath. Surely, it's not unreasonable to spend the same amount to stop the needless deaths of 20,000 Americans each year because they lack adequate access to health care.
Health care reform legislation now pending is imperfect; whatever results will require refinement and concessions by all those involved in health care delivery. But it is an essential start.
In my position, I have the privilege of directing nearly 200 people in their work to find better ways to deliver care and find answers to complex and confounding diseases. But if we can't do this for everyone, what have we accomplished?
When more than 70 million Americans are unable to benefit from our important medical advances, our achievements are hollow.
Dr. Ralph deVere White is director of the UC Davis Cancer Center.
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