In executing its charge, this committee has studied the available data and applied rigorous scientific criteria to set the record straight on the issue of health insurance coverage. The findings presented in the previous chapters and summarized below have expanded upon earlier IOM research on the consequences of being uninsured. The body of evidence on the health consequences of health insurance is stronger than ever before.

Lack of knowledge is not the problem. Preventable suffering related to uninsurance continues and promises to get worse rather than better. Inaction will lead to further erosion of coverage. There always has been, and will continue to be, uncertainty and disagreement about the best way to address major issues of public policy. The issue of cost, in particular, is daunting. But the nation has been successful with other complex issues that are intertwined with deeply held interests and ideologies. The opportunity to make the necessary difference is never the perfect one. Now is the time to act, emboldened by the knowledge and compassion of a society that truly cares about its members and that has a history of tackling difficult problems.

There is a compelling case for action. Simply stated: health insurance coverage matters. Expanding health coverage to all Americans is essential and should be done as quickly as possible. It is also of paramount importance that steps be taken to reduce health care expenditures and the rate of increase in per capita health care spending so that health insurance coverage for all can be achieved and sustained in an economically and politically viable manner. The committee does not believe that action should be delayed pending the development of a long-term approach to underlying health care costs. Given the demonstrated harms of not having health insurance for children and adults, the committee believes that actions to achieve coverage improvements should proceed immediately.