Caring for the Uninsured and Underinsured

There is a consensus among nearly all neurologists, as well as other groups of physicians and the general public, that a nation with the resources of the United States should make basic health care (including neurologic care) available to all citizens. At present, there are approximately 31 to 37 million Americans uninsured, including 16% of children under the age of 15 years, even though annual health care expenditures now exceed $600 billion (or 11% of the gross national product). 1 As the burden of paying for the excellence and excesses of our health system increases, the system's dropouts are mainly poor people and inner city hospitals. For example, patient encounters with physicians are 15% greater for white than for black citizens, even though twice as many blacks perceive their own health as fair or poor. 2 In the spring of 1991, the Journal of the American Medical Association and the