Girl in DC: Why health care should be paid for by society

[girl in washington]

Anyone who followed the recent health reform debate knows that our American health care system is not rational, efficient, equitable, or particularly suited to promoting health and wellness. A central theme in the debate focused on our Big Talk question of the month—who should pay—and the answer never became clear. This is partly because our health system is incredibly complicated. And I think it’s also because of the way we think about health care in this country: that some people are deserving enough to have their health care be publicly provided, and others are not.

That’s why we have disjointed programs like Medicare (for the elderly and eligible nonelderly disabled people who qualify for Social Security Disability Insurance (SSDI)), Medicaid (for children, pregnant women, the disabled, impoverished elderly (“dual eligibles”), and in some states, impoverished childless adults), the Children’s Health Insurance Program (CHIP; for children whose families make too much to qualify for Medicaid but too little to buy private health insurance), TRICARE (for military families) and the Veterans Administration (for the military).

Does it make sense to have a system that is so fragmented? Absolutely not. We acknowledge that society should provide care for people who cannot provide for themselves, like children and the disabled. And we have put programs in place that reward certain people, like workers (who qualify for Medicare after age 65) and veterans. What about the rest of us? There are ideological and practical reasons to believe that the majority of health care costs should be paid by the larger society:

1. Health is vital for a good quality life, and thus should be a basic right. You aren’t going to get far in the pursuit of happiness if you aren’t healthy, or at least the healthiest you can be.
2. In the aggregate, the health of individuals affects the system as a whole. This is especially apparent in the nation’s economic productivity. Sick people don’t make good workers.
3. Sick people may also lead to more sick people, as in the case of infectious diseases.
4. Many situations requiring health care are extremely expensive and unexpected (cancer, car accidents, etc), making saving for health-related expenditures difficult.

The real goal of health care is to keep people healthy, and on a larger scale, to create a healthier nation. Restricting health care to those who can pay doesn’t accomplish either of these goals, and in the long run, leaves those who can pay worse off. That doesn’t get into the nitty gritty of the follow up question to “Who should pay?”--“How much?”. That’s what careers in health policy are for.

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Some interesting facts about Medicaid:
• The disabled and the elderly dual eligibles make up 25% of the beneficiaries but account for nearly 70% of the spending
• The most expensive beneficiaries (the top 5%) account for more than half of Medicaid expenditures.
Source: Urban Institute and the Kaiser Commission on Medicaid and the Uninsured