Health Care

Like housing and tax policy, U.S. health care policy is badly in need of reform. The United States spends more on health care than any nation in the world. Within a few decades, the escalating costs of health care could prove catastrophic for the economy as a whole. Every year, tens of millions of Americans go without health insurance, mainly because they can’t afford it or because they lose a job and with it their insurance coverage. Some people discover that their insurance company has suddenly decided to stop covering them.

It’s easy to look at a person who is diabetic because of obesity and think that this person’s problem is self-control. It’s harder to make such a simple judgment once you realize that there are no places to buy healthy foods. On the Blackfeet Indian reservation in Montana, it’s a half-day drive to the nearest supermarket. Nutrition programs are helpful, but they don’t solve the food-access problem in a community with only fast food and convenience stores.

“I have routinely asked doctors and hospital administrators how much of the health care services we provide is pure waste,” says Guy Clifton, MD, the author of Flatlined: Resuscitating American Medicine. “They would usually pause to think, and then I would suggest, “Thirty percent?” They invariably responded, “Oh, at least that.”

“Nationally, a quarter of [insurance] firms cancel coverage immediately when an employee suffers a disabling illness; another quarter does so within a year,” states a report by the Cambridge Health Alliance, investigating why 60 percent of all U.S. bankruptcies are linked to medical problems. The victims are not usually poor but rather fit into the middle class. Ironically, most have insurance, at least at the beginning of their ordeal.

One could hardly find a starker, more grievous example of inequality than the difference between those families with health insurance and those without. Without health insurance, the risk of financial ruin is ever present. Health care policy exemplifies a system in which families can play by all the rules—go to work, spend their money responsibly, provide for their children as best they can—and still be denied the lowest common denominator of economic security. Since 1999, employer-based health insurance premiums have increased by 120 percent, and health care debt is now the main cause of personal bankruptcy.

In Perry County, AL, diabetes rates are five times the national average. The county has been described as a “food desert,” meaning there is extremely limited access to healthy foods. Frances Ford, who grew up in Marion, the county seat, remembers a choice of three grocery stores in the 1960s and 1970s. Now there is one. The high rates of obesity and diabetes are related to the lack of access to healthy foods, and not having adequate health care services makes the situation that much worse.

Frances Ford is determined not to let Perry County, AL, go without health care. A registered nurse, Ford lives in Marion, the county seat, where she grew up. In 2001, Ford left her job at a hospital in Selma, an hour away by car, to work for the Alabama Cooperative Baptist Fellowship as the coordinator of its Sewing Seeds of Hope project in Perry County.

Every American should be guaranteed a basic level of health care coverage. For those who earn too little to pay for insurance, the government will need to offer subsidies to help them afford the cost of a basic plan. Universal coverage is not just a goal of reform—it must be a requirement. Determining what constitutes a basic level of care should be left up to unbiased experts.

Major health care reform has been attempted by several presidents. President Franklin Delano Roosevelt made the first serious attempt to establish a national health care program, but was discouraged from pushing for it when he faced strong opposition from the American Medical Association (AMA). At the time, health care costs made up a much smaller share of family expenses than they do today. The public was not clamoring for a national health care program, and Roosevelt decided that his administration had enough problems to address without taking on a bruising battle with the AMA.

In 2009, U.S. workers experienced one of the worst downturns in the economy since the Great Depression. Job losses were the norm in almost every sector. But one sector that continued to see robust growth in spite of the recession was health care. People may decide to put off the purchase of a home or car, they may even cut back on food and other household needs, but they seldom have the luxury of scheduling a broken hip or heart attack for good economic times, or of ignoring a chronic illness or other debilitating condition.