I’m no Pollyana but I think there may actually be some hope on the horizon when it comes to health care reform. For one thing, the system as we know it is so broken there is only one way to go and that is toward viable systemic change that will improve access, and hopefully quality care, for measurably more people. We also have in our new leadership people who understand the issues, care deeply about them, and believe that health care is a fundamental right, not a privilege. Add to that numerous organizations making their voices heard at the highest levels of government and there may be an opportunity here to create, at the very least, a more equitable health care delivery system that will render us more effective in caring for all our citizens and make us feel less ashamed as one of the world’s wealthiest nations.
One of the reasons I feel cautiously hopeful – I cannot bring myself to say optimistic yet – is that some good ideas are being brought to the table from a variety of quarters. For example, Health Care for American Now, a national grassroots campaign representing a large number of organizations, is mobilizing millions of Americans around the issue of quality, affordable health care for all. Collectively they are calling for choice when it comes to insurance plans as well as regulation of insurance health insurance companies.
The National Council for Research on Women (NCRW) and other research, education and advocacy organizations have drawn attention to the fact that women and girls have additional needs that require urgent attention and have pointed to health disparities and inequalities in disease research and access to services that must be addressed. They are helping to guide the development of policies that will reflect an understanding of how important it is to offer portable health plans, reproductive health coverage that is value-free and comprehensive, and age-appropriate sex education.
The NCRW and others are pushing hard for creating a system of universal health care because the facts speak for themselves. Since the 1960s health care spending in the U.S. has accelerated faster than in any other economic sector. In 2005 national health care spending amounted to nearly $2 trillion or 16 percent of GDP. Within the next ten years health care spending is estimated to reach $4 trillion, or 20 percent of GDP. These figures are simply unsustainable.
The U.S. remains 29th among industrialized nations when it comes to infant mortality despite high tech and increasingly medicalized pre and post-natal interventions, according to the Centers for Disease Control and Prevention. And a 2008 Commonwealth Fund survey of chronically ill adults in eight developed countries found that patients in the U.S. are at particularly high risk of forgoing care because of costs or inefficient and poorly organized service delivery. As Judy Norsigian of the Boston Women’s Health Book Collective wrote (with Eugene Declercq) in an editorial on the Boston Globe’s website last November, President Obama will have to “address the critical issue of why the U.S. has such poor health outcomes despite all the money we spend.”
Senator Max Baucus (D – MT) is among several legislators pushing specific action plans for health care reform at the federal level. In a November “call to action” he unveiled a “blueprint” designed to achieve universal coverage, reduce costs, improve quality of care, and institute insurance reforms. The plan also addresses waste, fraud and accountability. In releasing it Baucus said, “In 2009, Congress must take up action and act on meaningful health reform legislation that achieves coverage for all Americans while also addressing the underlying problems in our health system. The urgency of this task has become undeniable.” No doubt the plan will be debated and probably diminished as the dialogue around health reform takes place but it is significant that Congress at last recognizes that it must come together to act on this priority.
In the non-profit sector The Commonwealth Fund released a 2008 study entitled “Building Blocks for Reform” which offers a new framework for providing insurance coverage. It builds upon the current U.S. system of mixed private-public insurance options and proposes expanding Medicare while maintaining the current role of employer-sponsored insurance.
In some cases state health care reform is providing new models for consideration. According to Adam Thompson, a health policy analyst with Progressive States Network, “the political environment in states for reform couldn’t be better.” Lawmakers at the state level are being decidedly proactive, says Thompson. Public pressure is rising and while budges pose challenges, they are not an insurmountable barrier. There is growing support for investing in Medicaid and the S-CHIP program aimed at improving health outcomes among children. Thompson thinks there will be more collaboration between state and national government and sees the huge gains made by progressive politicians in state houses across the country in the recent election as a sigh that change is coming.
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