citizenship or social membership that apply universally in the United States. Thus the Committee asks the converse question: What do we as a nation stand to gain by ensuring that all Americans have health insurance coverage? The Committee concludes that adopting a policy of universal health insurance coverage would be a societal expression of values and norms that are deeply, if sometimes obscurely, embedded in American culture and history.1

Box 6.1 at the end of the chapter consolidates the Committee findings from previous chapters as well as this one.


Conclusion: The estimated benefits in terms of the value of healthy life years gained by providing coverage to those currently uninsured are likely greater than the incremental societal costs of the additional health care services that they would receive if insured. The costeffectiveness of the additional health care that the uninsured population would use with coverage is comparable to that of many other health-enhancing and life-extending interventions.

In its reports and analyses so far, the Committee has thought about and depicted the relationships among the various hypothesized and documented consequences of uninsurance in terms of a series of concentric circles, broadening outward, as in Figure 1.1. Because the Committee has considered health insurance primarily as it facilitates the receipt of health care by individuals, the health consequences for individuals are at the center of the circle. Immediately “ringing” the circle of uninsured individuals are their family members, a greater number of persons than the uninsured themselves who are at risk for adverse health, psychosocial, and economic impacts related to the uninsured status of a family member. One ring further out from families represents the communities in which uninsured persons and their families reside. Communities with higher-than-average uninsured rates comprise a larger population than that of the families that have at least one uninsured member. Residents of these communities may experience reduced access to health services even when they are insured themselves. Finally, ringing the communities is American society overall, where all members who pay taxes, purchase goods and services, and benefit from the presence of an educated and


See Habits of the Heart: Individualism and Commitment in American Life by Robert Bellah and colleagues (1985). Through in-depth interviewing and qualitative analysis, these social scientists explore Americans’ articulations of cultural and ethical values related to civic and political life. They conclude that, while the values of freedom of action and self-reliance were readily invoked by respondents, collective responsibility and mutual concern among neighbors and fellow citizens were also deeply held values that guided conduct, as described by respondents, but were not as clearly articulated.

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