More than 2,400 doctors, nurses and health advocates denounce Institute of Medicine’s health coverage recommendations

IOM panel ‘riddled with conflicts of interest’ in violation of agency’s own guidelines, signers of protest letter charge

Dec. 1, 2011

Steffie Woolhandler, M.D., M.P.H.
Oliver Fein, M.D.
Danny McCormick, M.D., M.P.H.
Mark Almberg, PNHP, (312) 782-6006,

In a letter (appended below) sent to Secretary of Health and Human Services Kathleen Sebelius and posted on the Internet today, more than 2,400 physicians, nurses and other health advocates condemn the recommendations of an Institute of Medicine (IOM) committee regarding the “essential benefits” to be mandated under the 2010 federal health reform law.

The signers, most of whom are physicians, charge the committee’s recommendations amount to prescribing skimpy coverage that would “sacrifice many lives and cause much suffering,” and urge the Obama administration to reject them.

“The IOM panel endorsed insurance coverage similar to that offered by small employers rather than the more comprehensive coverage offered by large employers,” said Dr. Danny McCormick, an internist, assistant professor at Harvard Medical School and former IOM fellow who helped circulate the letter. “The recommendation was widely viewed as a victory for the health insurance industry, which has long opposed mandating comprehensive benefits.”

The panel also recommended that coverage under the new law be defined by a premium target – an approach often called “defined contribution” – rather than by a list of medically necessary benefits, McCormick said.

The protest letter accuses the IOM panel of being “riddled with conflicts of interest” and notes that many of the panel members have “amassed personal wealth through their involvement with health insurers and other for-profit health care firms” whose businesses would be affected by the panel’s recommendations.

The IOM committee’s members include Sam Ho, executive vice president of UnitedHealthcare; Leonard D. Schaeffer, director of the biotechnology company Amgen and former chairman and CEO of WellPoint (Schaeffer’s family foundation donated $2 million to the IOM in 2010); as well as executives from 3M Health Information Systems, a medical supplier, Milliman Inc., an actuarial consulting firm with close ties to the insurance industry, and The Blackstone Group, a private equity firm with major health care interests. The IOM’s full list of panel’s members, with a partial listing of their affiliations, is accessible here.

“Many committee members’ strong ties to the health industry violate the guidance offered in a 2009 report issued by the IOM which recommended that those with industry conflicts of interest should generally be excluded from such panels,” said Dr. Steffie Woolhandler, professor of public health at the City University of New York and visiting professor of medicine at Harvard Medical School, who served as an IOM fellow in 1990-1991. Woolhandler also circulated the letter.

The signers of the protest letter include several prestigious members of the IOM, as well as several former fellows. The letter was first circulated to colleagues by attendees at the IOM’s annual meeting near Washington in October. After learning of the letter, IOM officials instructed security officers to block its distribution at the meeting.

The letter was also circulated by Physicians for a National Health Program, which advocates for a single-payer health system, and by other health professional groups.

Besides being submitted to Secretary Sebelius and other administration officials, the letter has been accepted for publication in the International Journal of Health Services, Woolhandler said.

An Open Letter to Secretary Sebelius and President Obama regarding the Institute of Medicine’s recommendations on the Essential Benefits under the 2010 Health Reform Law

We protest the Institute of Medicine’s (IOM) recommendation that cost rather than medical need be the basis for defining the “essential benefits” that insurance policies must cover when the federal health reform law takes effect in 2014. If adopted by the Department of Health and Human Services, this recommendation will sacrifice many lives and cause much suffering. We call on Secretary Sebelius and President Obama to reject them.

The IOM proposal would base the required coverage on the benefits typical of plans currently offered by small businesses – enshrining these skimpy plans as the new standard. These bare-bones policies come with a long list of uncovered services and saddle enrollees with unaffordable co-payments and deductibles.

Already, millions of underinsured Americans forgo essential care: adults with heart attacks delay seeking emergency care1; children forgo needed primary and specialty care2; patients fail to fill prescriptions for lifesaving medications3; and serious illness often leads to financial catastrophe4.

The inadequate coverage the IOM recommends would shift costs from corporate and government payers onto families already burdened by illness. Yet this strategy will not lower costs. Delaying care often creates even higher costs. Steadily rising co-payments and deductibles over the past two decades have failed to stem skyrocketing medical inflation. And nations that assure comprehensive coverage – with out-of-pocket costs a fraction of those in the United States – have experienced both slower cost growth and greater health gains than our country.

Our patients urgently need what people in these other nations already enjoy: universal and comprehensive coverage in a nonprofit system that prioritizes human need over corporate profit.

The IOM committee was riddled with conflicts of interest, many members having amassed personal wealth through their involvement with health insurers and other for-profit health care firms. Its recommendations were lauded by insurance industry leaders who have sought to undermine real health reform at every turn. As the Lancet noted on its Dec. 5, 2009, cover: “Corporate influence renders the U.S. government incapable of making policy on the basis of evidence and the public interest.”5

Sadly, the committee’s damaging recommendations suggest that this corporate bug has also infected the IOM.

1. Smolderen KG, Spertus JA, Nallamothu BK et al. Health Care Insurance, Financial Concerns in Accessing Care, and Delays to Hospital Presentation in Acute Myocardial Infarction. JAMA 2010;303:1392-1400.

2. Kogan MD, Newacheck PW, Blumberg SJ et al. Underinsurance among Children in the United States. N Engl J Med 2010;363:841-51.

3. Doty MM, Edwards JE, Holmgren AL. Seeing Red: Americans Driven into Debt by Medical Bills. The Commonwealth Fund, August 2005.

4. Himmelstein DU, Thorne D, Warren E, Woolhandler S. Medical Bankruptcy in the United States, 2007: Results of a National Study. Am J Med 2009;122:741-6.

5. Cover. The Lancet: Volume 374, Number 9705, 5 December 2009.

Physicians for a National Health Program ( is an organization of more than 18,000 doctors who support single-payer national health insurance. To speak with a physician/spokesperson in your area, visit or call (312) 782-6006.