The Politics of Health

Last week’s final presidential debate focused on domestic and economic policy, yet I doubt that many listeners found clarity in the candidate’s positions on health care reform.

What do they agree on?  Rising health care costs are swallowing-up ever larger portions of GDP, hurting American businesses’ ability to compete in the global marketplace, and yet, an unacceptable number of Americans, including many working families, are without timely and appropriate access to primary and specialty care due to lack of insurance.  Unpaid medical costs are the number one cause of bankruptcy in America.

What do they disagree on?  They disagree on how to rob Peter to pay Paul.  Obama will cover children who are currently uninsured through something akin to a parental mandate to purchase health insurance, and he’ll make available the health insurance plan options provided to US government workers and senators so that small businesses and others disadvantaged by adverse risk-pooling can find insurance more affordably than when searching for individual coverage.  McCain will tax employee health benefits while providing a $2500-$5000 tax credit to individuals and families to encourage them to purchase health insurance in the marketplace, while allowing insurance companies to market regionally or nationally rather than being bound by state-to-state regulations.

What neither said.  None of these plans will do much to lower health care costs.  At the risk of oversimplifying, I see 3 ways to lower health care costs: fund public health and primary care initiatives that focus on prevention (“an ounce of prevention is worth a pound of cure” - or perhaps nowadays we say a few hundred dollars worth of prevention is worth several thousands of dollars worth of cure,) reduce duplication and waste while driving improved quality and patient safety (the mantra of the health IT community and other proponents of electronic medical records,)  launch a thoughtful public discussion of what sort of care is optimal for patient and family comfort near the end of life.  Palliative care, more humane and patient-centered than routine care, aims to provide comfort rather than life extension when there is no cure, nor reasonable expectation for prolongation of life.  

Obama and McCain are partially, incompletely, addressing #1 and #2.  Regardless of who wins the election, there is much work to be done to address the inequities and spiraling costs of health care.  Meanwhile, seventy five percent of US health care costs are driven by our toxic lifestyle: smoking, overeating, lack of exercise, stress, and alcohol/substance abuse. 

In this election season as we ponder what we want in our politicians its incumbent on each of us to do our patriotic best to eat well, exercise, and be a change agent for our communities including those whom we love.  After all, our very way of life depends on it!

Jan