The Looming Health Care Crisis

An Op-Ed submission by three Harvard School of Public Health students: Alana Wooley, Katelyn Mack and Jamie Zwiebel. For your reading pleasure. Comments welcome!

As our government leaders grapple with the current economic crisis, another crisis is gaining momentum. We can no longer ignore its symptoms: rising rates of preventable, chronic illnesses; Americans facing trade-offs between doctor visits, prescription drugs, mortgage payments, gas or food; financial concerns determining patient treatment for catastrophic illnesses; and an inability to obtain insurance with a pre-existing illness, among others.  In 2007, 45 million Americans were uninsured.  These numbers will no doubt continue to climb as families and employers alike increasingly feel the direct impact of rising unemployment and inflation.  If we do not address the looming health care crisis, we will undeniably face yet another bailout, this time for health insurance companies and the health care community.

In the most recent presidential debate, Senator Barack Obama (D) told the nation he believed health care is a right and Senator John McCain (R) believed health care is a responsibility.  Whether it is a right or a responsibility, both candidates believe that access to and affordability of health care are important.  While we may disagree about solutions to and responsibility for the health care crisis, 51% of Republicans and 79% of Democrats believe that our nation’s broken health care system is in need of repair (Blendon et al. 2008). While the Presidential candidates agree that something needs to be done, their health care proposals are in vast opposition to one another. 

Senator McCain offers a short-term solution to this imminent crisis.  His health care plan proposes a $2500 and $5000 tax-credit for individuals and families, respectively, to help absorb the rising costs of health insurance.  However, not only is this credit, which is payable only to the insurance companies, considered taxable income, it does not address rising premium costs and treatment expenses.  While this tax credit may be beneficial for young, healthy adults, it would exacerbate the financial burden of health insurance for families and adults living with chronic or catastrophic illnesses. Simply offering a tax-credit to help deflect expenses for an already expensive health care system is not a sustainable solution and one that will be ineffective in reducing the rising numbers of uninsured Americans. 

Senator Obama offers a more comprehensive, long-term solution to the health care crisis. He proposes allowing individuals and families to keep their current employer-offered health care, or opt into a public insurance or obtain private insurance coverage through an insurance clearinghouse. The public insurance would offer coverage similar to that which Senator Obama and Senator McCain have as government officials. Contrary to rumors of socialized health care and fines for not obtaining insurance, this proposal only mandates health insurance coverage for children.  Senator Obama offers a more comprehensive plan that would extend insurance access to those whom the current system does not capture.  While this plan would reduce the number of uninsured Americans and improve coverage for children and families, Senator Obama’s plan would not cover everyone.

The health of our nation is central to the health of our workforce, the strength of our families and communities, and our national security. This election is an opportunity to ensure that the housing and credit woes we now face do not similarly beset the fragile US health care system.  As voters, we must elect someone with sound judgment and visionary thinking.  We can no longer afford short-term solutions.  Our next President must offer long-term, sustainable solutions to the long-standing dysfunction and discord of the US health care system. Let us enter the polls with the economy, health care, and education on our minds, all of which are inextricably linked together. Now is the time.  It is our responsibility to avoid another bailout blunder by electing the candidate with the best solution to improving the health and well being of all Americans.

Health Care: Head to Head

The Wall Street Journal recently assessed Obama and McCain's health care plans (October 23, 2008; Personal Journal Section, D1). Depending on your income, health status and what kind of insurance you currently have the plans may have different effects on your insurance situation. The WSJ concluded that Obama's plan would tackle the large (and growing) uninsured population, but both plans could reduce out-of-pocket spending for Americans in the short-term.

How much will each candidates' health insurance programs cost? The Tax Policy Center has suggested both plans will cost between 1.3 (McCain) and 1.6 (Obama) trillion dollars over 10 years; however, the Lewin Group determined McCain's plan would cost almost twice as much as Obama's plan ($2.1 vs. 1.2 trillion). 

Both candidates plan to use money from taxes (by rolling back the Bush tax cuts) or other incentives (taxing employer health benefits) to offset the costs of their health care proposals. I encourage you to read the full article if you have a chance.

Happiness & Health

What makes you happy? 

What betters your quality of life?

What leads to a long life?

These three questions can be answered by one simple word. Not a gene nor a new-and-improved medical intervention can guarantee happiness or a long life. It is not how much money you earn (or save) or even where you live. Increasingly, evidence is showing that relationships make a difference in how happy and healthy people are.

Two people who I have the utmost respect for recently asked these questions and both came to the same conclusion; that our social relationships (i.e., how we connect with others) matters for our emotional, psychological, and physical well-being. Our social ties -- friends, family members, coworkers -- have an incredible influence on our happiness and health. A few weeks ago in class, Ichiro Kawachi provided numerous examples of emotional and material support provided by friends and family during times of difficulty and how this can improve health outcomes and positive health behaviors. 

Then this past weekend I was listening to a podcast by John Ortberg who was talking about what makes human life flourish (i.e., people be joyful). He said we experience genuine caring it is like "the roots of your soul are getting fed, and that's coming up into your being and making you strong. Every life has to have that connectedness." He gave many examples of how our relationships, specifically, taking risks and being vulnerable in relationship is critical to fostering joy in our life. And if life is full of joy, despair and anxiety are less likely to take their toll on health. 

If you are more interested in the idea of social relationships, happiness, and health check out these resources:

• Social Capital and Health by Ichiro Kawachi, SV Subramanian, and Daniel Kim
• EveryLife Needs a Cheering Section sermon by John Orberg, MPPC
• Bowling Alone: The collapse and revival of American community by Robert Putnam

Health Care: A Right?

In the second Presidential debate of the season, the two Presidential candidates were asked whether they believe that health care is a privilege, a right, or a responsibility. 

Senator McCain responded:

"I think it's a responsibility, in this respect, in that we should have available and affordable health care to every American citizen, to every family member. And with the plan that...I have, that will do that. But government mandates I -- I'm always a little nervous about. But it is certainly my responsibility. It is certainly small-business people and others, and they understand that responsibility. American citizens understand that. Employers understand that."

I had trouble figuring out what McCain meant by saying health care is a responsibility since he followed that up with "we should have available and affordable health care to every American citizen." After going through his health care proposal I have come to understand his response as: it would be his responsibility as President to encourage the market (employers and insurance companies) to provide health care for American workers. He does not believe that increases in health care accessibility and affordability should result from increases in government spending on health care. But what about the people who cannot afford to work enough hours to be eligible for employer-based insurance (due to economic turmoil, layoffs, or family responsibilities)? What about the elderly? The disabled? What about the hard-working Americans who are working double-duty shifts and yet still earn less than half the median income-- not enough to pay $5-8,000 out-of-pocket for quality health care coverage for their family? Whose responsibility is it then? If it is the government's responsibility to provide access in these cases, the government is not doing enough.

On the other hand, here is Senator Obama's response:

"Well, I think it should be a right for every American. In a country as wealthy as ours, for us to have people who are going bankrupt because they can't pay their medical bills -- for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they're saying that this may be a pre-existing condition and they don't have to pay her treatment, there's something fundamentally wrong about that."

That health care is a human right is widespread belief. The preamble to the World Health Organization Constitution declares "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition." Recently, the Office of the United Nations High Commissioner for Human Rights and the World Health Organization released "The Right to Health," a fact sheet that seeks to outline the basic understanding of what "the right to health" is and "its implications for specific individuals and groups." 

While no country has a perfect health care system, some certainly have achieved more equity and better health outcomes than what we observe in the US. Ours is a system driven by capitalist principles for all but the most impoverished families (who are eligible for Medicaid and SCHIP). While I have heard it argued that no one can be turned away from medical services for immediate life-threatening illness or injury, we all know that chronic health conditions are increasingly placing a burden on our system in terms of human and financial resources. Plenty of studies (including an upcoming publication in Journal of Women's Health -- woohoo!) support the notion that men and women without health insurance are less likely to access and receive preventive health services. This results in later disease complications and even (preventable) death. I will readily acknowledge, however, that providing health insurance to everyone is not a magic bullet solution to the current state of (ill-) health  in our country.

What are your thoughts on health care as a right or a responsibility? Do you think health care rights include social conditions such as safe drinking water, adequate nutrition, proper housing, and gender equality? What about access to essential medications, preventive health services (screening, education, vaccinations), reproductive health services? Why?

Finally, will the country's looming health care crisis factor into your vote on November 4th? 

Comment! I know you want to.

Update: America's Health Insurance Plans investigated the average cost of health insurance. While premiums for families varied widely depending on the State in which you live, the average cost was $5799. In Massachusetts, the average cost was over $13,000. Obviously, there are huge differences as well in what you get for $6000 family insurance in terms of deductibles, preventive care, and copayments. 

Bailout: the $810 billion bombshell

There was a great op-ed written by Joel Berg in last week's Washington Post. He wrote from a social services advocate's perspective on the looming government bailout of failing financial institutions. While I acknowledge that some remedy is needed for the mess that lenders have gotten themselves into by thinking the housing bubble would never burst. I am nonetheless baffled by the shear magnitude of the cost. Now, we are learning that the $700billion initially proposed has grown to $810billion (...because of pork?!) -- I am forced to reflect on what this money actually means. Our politicians can talk about the need for social protections, serving "the people", providing for families, communities, and the country. But talk is cheap. True values are revealed by where we spend our money (and our time). Thus, this bailout may (I hope) mean more than rescuing troubled Wall Street investors; rather, it represents a greater value of protection of our livelihoods and lifestyles -- being able to own and keep one's home, start a new business, invest in our children's future education. The details and implementation of this bailout bill will further reveal the underlying values and priorities of those whom we entrust the future of our nation. 

Back to reflection upon this $810billion. What would I do with $810 billion? Would I provide food for the hungry? Legal counsel for the oppressed? Food for the malnourished? Mobile technology for the isolated? Job training for low-wage workers? Bed nets in malaria territory? Funds for non-profit organizations? 

What would you do with $810 billion dollars?