Health, Medicine and Society Program

Access is not enough

Access is not enough. Health insurance must be accessible and affordable for all Americans not only because it is socially just but also because it will help our country achieve a system that is effective and efficient. Insurance for all is essential so that more care is provided at earlier stages, when it is most effective and least costly. But we can't stop there. Access alone will not drive the improvements needed to increase safety, reduce waste, enable coordination and promote quality. Consider, too, that in recent years nearly 40 percent of insured Americans reported having trouble getting the care they needed. Providing access to all without a greater focus on prevention and significant improvements in the delivery and value of care is simply not affordable or sustainable.

Insurance for all is essential because today’s lack of access to preventive and early stage care drives up costs in the United States Many people present for care at the later stages of disease that are more difficult to treat effectively and more expensive than those diagnosed earlier. People also present in the most expensive settings (emergency rooms) because they lack other access to care.  Insurance for all that provides access to preventive and early stage care will improve efficiency. It will also make every patient a paying customer. The focus can move away from shifting cost burdens to someone else, to the truly important efforts of enabling health and improving care.

But today, many Americans still face obstacles in receiving quality care, regardless of insurance status. Thirty-eight percent of insured individuals reported that they or a family member had problems accessing health care.1 A growing number of patients report being unable to schedule timely appointments with their physician, leading to emergency departments’ overflow and overuse. Disputes over what insurance covers also undermine actual access.  Moreover, access to effective and high quality health care is undermined in today’s system by care delivery that lacks coordination, lacks shared information, and has far too many errors and far too much variability in quality. Insurance alone will not fix these fundamental problems.

Americans – young and old – should have the tools they need to become healthier. Affordable, accessible, high-quality health insurance is certainly one of those tools. However, it is only one element of a much larger toolkit. Indeed, insurance for all will drive overall costs up unless we also restructure health care delivery, changing the culture in ways that will drive dramatic and ongoing improvements in health care and in enabling health.

[1] “Underinsured in America: Is Health Coverage Adequate?” Kaiser Family Foundation. Available: