The Institute of Medicine says the president and Congress should try to have universal health coverage in the United States in place by 2010. In a recent report, Insuring America's Health: Principles and Recommendations, the IOM's Committee on the Consequences of Uninsurance cites several factors underlying the need for universal coverage: the growing stress being placed on the nation's healthcare system, exacerbated health problems and the substantial societal costs that result from more than 43 million uninsured Americans.

"Achieving universal coverage will require federal leadership and support, regardless of which strategy is adopted to achieve this goal," said Mary Sue Coleman, a committee member and president of the University of Michigan, Ann Arbor.

"There are many thoughtful plans for extending health insurance already on the table. We leave the debate about the specifics of necessary health insurance reforms to elected officials, policymakers and the public."

The committee, however, did offer five guiding principles for expanding coverage. They are:

• Healthcare coverage should be universal.

• Coverage should be continuous.

• Individuals and families should be able to afford coverage.

• The health insurance strategy should be affordable and sustainable to society.

• Healthcare coverage should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered and equitable.