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     According to the Kaiser Commission on Medicaid and the Uninsured, longer periods without coverage are more common and occur when the person’s employer does not offer coverage, when the person cannot afford premiums, when health conditions make the person uninsurable in the private market, when a spouse’s benefits are lost because of divorce or death, or when the person does not qualify for public health coverage. The report also states that persons with low incomes and those in fair or poor health are significantly more likely to be uninsured for longer periods, and that young adults (19 to 34 years of age) are at greater risk of being uninsured for longer than 12 months compared with those in other age groups. The long-term uninsured are much more likely to lack a usual source of care than those who are uninsured for five months or less (Neff, 2004).

     Inequitable financing of health care contributes to the current level of preventable mortality and morbidity among children and pregnant women in the United States.  Children without a usual source of care may be at increased risk of adverse outcomes, including not receiving needed immunizations.  Previous research indicates that children without health insurance are more likely to lack a usual source of care, a regular clinician, and access to after-hours medical care than are those with coverage (Weinick & Krauss, 2000). There is growing evidence that access to comprehensive and continuous care, including preventive care and behavioral and mental health services, leads to positive health outcomes and decreased health expenditures. Poor and near-poor children who were up-to-date on their well-child visits in the first 2 years of life had fewer avoidable hospitalizations. Expansion of ambulatory care coordination and other supportive services led to decreased lengths of hospital stays and total inpatient expenditures among children with chronic conditions.  Comprehensive follow-up care decreased the risk of life-threatening illness in the first year of life among high-risk inner-city infants without increasing costs. Although the establishment of the State Children’s Health Insurance Program (SCHIP) has not created universal coverage for children, it has been an important opportunity to expand insurance coverage to a large portion of uninsured children (American Academy of Pediatrics, 2003).

      The debate for health care reform throughout the later part of the 20^th century has currently shifted into two basic arguments: (a) continued but focused incremental reform to universal health care coverage, and (b) change to a single-payer national health insurance system. The incremental approach, over as long as 7 years, is based on the assumption that a single-payer system would never get through the U.S. Congress (Tooker, 2003). The idea of focused incremental reform is to improve those areas of health care coverage that can be enacted into current legislation, such as expanding existing public insurance programs or providing tax credits to the uninsured for the purchase of private health insurance (Oberlander, 2002). However, extending health care coverage incrementally will continue to increase costs and spending while creating a multi-tiered, unequal system of care delivery, unless additional resources within the existing system are found and re-allocated (Himmelstein & Woolhandler, 2003).  The tax credit proposal is flawed, because the amount of proposed tax credits will not cover the cost of the insurance premiums.

     The proposed single-payer national health insurance plan bases its argument on the premise that the current HMO/PPO bureaucracy consumes almost 30% of all the monies designated for health care, a layer of administrative bureaucracy that is uniquely American (Himmelstein & Woolhandler, 2003). By reducing this bulging bureaucracy, an estimated $140 billion could be saved annually, leaving more than enough funding for the uninsured and the underinsured. A recent study evaluating the California Health Service Plan (CHSP) has shown that a single government payer linked to public authority and accountability can effectively finance health care and significantly save on health care spending, while improving the health of the population (Shaffer, 2003). Both politically and fiscally, a national health insurance could not only improve medical care for the poor but also for the majority of insured Americans.

Universal access to quality health care is a basic human right of every member of our society, and that the inability to guarantee that right is evidence of a failure of our society that must be addressed.  Even those with good insurance are scared about gaps in coverage, higher premiums, and all the deductibles. Or we fear losing our job and, with it, the health insurance (Massachusetts Nurse, 2005).  The advantage of National Health proposals is that they are actually better for most people: benefits are more comprehensive, out-of-pocket costs are lower, and there are fewer restrictions on access.   But convincing people of these advantages is not easy. It’s hard enough for organizers, let alone the average citizen, to follow the distinctions between one plan and another.  The federal government should be accountable to us and not insurance companies and drug companies.  The basic goals of federal reform should be to: (1) provide coverage for everyone, because that is just and it is the foundation for controlling costs; and (2) achieve universal coverage in such a way that allows the system to continue to evolve towards greater equity and more effective cost controls.  Everyone in the country should have the option, and the means of paying for, coverage through Medicare or through private insurance. Such a proposal is built around familiar systems, and allows institutional forces to protect and even expand what they have now.