I’m away on a business trip till Monday so we have a guest blogger today.  Abby Gold is a PhD in Public Heath that works for both ND State Univ. and MN State Univ. She has posted several comments on Health Care on the Investors411 blog.  

       HEALTH CARE        

Think about all of the things we value as public goods in our country: roads, parks, schools, sanitation services, safety services, and clean water, just to name a few. As a society, we cannot live without these public goods. We also cannot live without health care. Yet health care has never really fallen into the category of a public good. This has cost us dearly.  

For a long time in the United States, we have treated access to health care as a privilege rather than as a right. As employer-based insurance has weakened and the ranks of the uninsured have grown, our national dialogue on health care has shifted as well. We are referred to as health care “consumers,” rather than patients, and care itself has been turned into just one more commodity for us to buy. The societal consequences related to this position are numerous, including the high utilization of expensive emergency care, children getting preventable diseases such as whooping cough, and a skyrocketing diabetes rate.

The historical hesitation of our lawmakers to pass meaningful legislation to create a fair and equitable health care system stems back to at least Eisenhower’s time, when the paranoia over “socialism” was just as alive then as it is today. David Oshinsky, in his book, “Polio: An American Story,” describes the polio vaccination’s seedy and complicated history. When it came to time to administer the vaccination on a widespread scale, researchers wanted to inoculate school children for free. Eisenhower was afraid to provide funding for free vaccination, thinking that it was too “socialistic.”  Never mind that the worst polio cases were primarily found in privileged children who were unexposed to the virus or other germs that could have sparked their own acquired immunity.

We don’t have a national health care system because people are afraid of socialism, and not because of a reasoned argument against assuring accessing to health care for all. But health care is not just about health insurance coverage; it also encompasses the care itself, including readily available, quality primary care. Do you have health insurance? If you are one of the 45 million Americans without health insurance, what sorts of things do you avoid or delay? Check-ups? Visits to the doctor when sick? Annual check-ups, even for young adults, are an important way to prevent disease. Annual exams for men should include sexually transmitted infection and testicular cancer screenings (of which younger men are particularly susceptible). Annual exams for women include pap smears, breast exams, and sexually transmitted infection screening. Early detection of most diseases can save lives and be far less costly to treat than later detection. 

Even worse, what if something catastrophic happens like you fall off a ladder and break your back, cut your finger with a knife while making dinner, or you get cancer?  Some things are more affordable to pay on your own, like stitches in your finger. But, some things are so costly that you will surely be paying the bill for a long time.

My sister, Katie, was diagnosed with breast cancer at age 31. Thankfully, she felt the lump on her own. Mammograms in women under 40 are not routine. She was diagnosed with a fairly treatable, early form of breast cancer. At the time, she was in business school and had just given up her comprehensive health insurance in exchange for the university’s student health plan, which only covered up to $100,000 of all medical costs. Initially, she felt comfortable with her decision to save some money on health insurance because of her youth and good health. The cancer changed that story. The cost of her cancer treatment was twice the amount covered by the university sponsored health insurance.

We need to transform our health care system. As much as we try to squeeze health care into a free market system where we shop around for the best deals, we will fail to solve the problem of providing coverage for all citizens. Nobody should live in fear of a bill causing us to forgo important medical treatment. This puts everyone at risk. If someone has strep throat, tuberculosis, or HIV we need to know who they are and treat them in order to prevent the spread of these potentially deadly diseases.

It’s so simple, yet so complicated. The ideal to cover everyone is simple, but the politics of covering everyone are complicated. We need to de-politicize the process. The question of who receives coverage and who doesn’t receive coverage furthers the disparity between rich and poor in this country. Family HealthCare Center in Fargo has estimated that over 22,000 people in our community do not have access to health insurance and do not have a medical home.

Now that the middle class is affected, maybe we’ll see some change. With heavy job losses in the professional world, people are losing their employee-based health insurance coverage at a rapid pace. Also, smaller employers are being choked by the high cost of insurance for their employees and opting out of paying for their insurance and maybe moving toward offering the option of health savings accounts.

A little bit about health savings accounts (HSAs) . . . HSAs are a free market approach to health care. Employers who offer this as a “benefit,” provide high-deductible catastrophic health insurance to their employees while at the same time deduct pre-tax money from paychecks that goes into an account to pay for any medical services accrued below the deductible. This approach might work for young, healthy people who rarely use the health system. The idea behind HSAs is that if people pay for more of their own health care they shop around for a clinic or doctor to find the best deal creating competition and driving down health care costs. Also, if you are young and healthy, you can save money in your HSA for many years almost like an IRA, so when it comes time to pay for costly health care expenses when you are older, you’ll have the money saved. This approach leaves out a great majority of Americans who need to utilize the health care system on a regular basis. In other words, it is inequitable. We need an equitable system that serves everyone.

Other countries view health care as a right, and their per person health care costs are a lot lower than ours, at least in part because they focus more on prevention and primary care. Our system is backward; only 2% of medical dollars are spent on prevention and public health measures. If we had a health care system that focused on preventing diseases before they emerge, our costs would surely go down. Instead of health care costs strangling state, local, and small business budgets, we could have a system that provides for everyone while also emphasizing prevention, leading to a healthier nation.

Right now, we have the opportunity to find a solution to our health care crisis and build a health care system that works for everyone. President Obama and the Congress have already taken a few small steps: they passed an expansion of the State Children’s Health Insurance Program (SCHIP) to cover millions more children. Also, the stimulus package included funding for the development of secure electronic medical records that will lead to better information management, and funded prevention and wellness efforts.

But that is only a start. Our leaders need to set a goal of passing comprehensive health care reform by the end of this year. The real debate is about to begin. Americans are coming together to have a conversation about how we can find a unique American solution to our health care crisis. It is time that we finally acknowledge and value our health as an American right, and provide quality, affordable health care for every man, woman, and child in America in a way that makes our economy stronger, and fairer, for the future. 



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