Health and Mental Health - Towards A Basic Level of Care
Many doctors, patients, and even insurers would argue that our current for-profit medical system is splintering and in need of overall repair. Our for-profit system has resulted in some marvelous advances, and people come from around the world to our high-tech facilities. At the same time we have higher infant mortality rates and shorter life spans than many other developed nations. For some, the care is excellent; for others, it is a nightmare. More than 47 million Americans have no health care insurance1. This lack of access to health care is one of the most important issues impacting poverty in this country, and we, and others, believe it is a problem that can be solved, and that it is in all our interests to solve it. Living in poverty precludes having disposable income for "extras" like health insurance even as it significantly increases the likelihood of ill health. The devastating impact of diabetes and asthma alone, modern-day plagues that prey on the poor, could be lessened if only the poor had access to basic health care and health education.
The occurrence of catastrophic illness is often what differentiates the sheltered poor from the homeless, as poor, uninsured patients with serious medical conditions are forced to make wrenching trade-offs. When they choose the care that might save their lives, their housing is frequently lost in the bargain. As Rosalynn Carter has told us, "poverty is the pathway to depression." Conversely, people afflicted with mental illnesses, including depression, are less likely to hold well-paying jobs and stay out of poverty. These health and mental health issues are especially concerning in the homeless, which itself can lead to depression and anxiety, and where serious illness can go untreated for prolonged periods. When the uninsured poor are sick enough to finally seek treatment, it is often in emergency rooms, perhaps after much needless suffering, perhaps after exposing others to communicable diseases, and certainly making very inefficient use of costly resources. If you do not care because of compassion, consider the following: an ounce of prevention is worth a pound of cure. It is ultimately less expensive to treat diseases early than late, and to have fewer cases of communicable diseases by catching cases as early as possible.
How can we make smarter decisions as a society, in light of an economic downturn and scarce resources, for the greater good? One problem that reformers must tackle is that providers of insurance have strong financial disincentives against taking a long-term view when looking at the costs and benefits in decision making. For example, for any operation that might allow someone to be a productive member of society rather than a burden, it is always more costly today to provide treatment than to deny care, so there would always be an incentive towards denial of care. At the same time, in part from our deep fear of death, we opt to prolong life at its close through drastic, heroic, often painful, and always costly measures. These and other examples show how we are already rationing health care in ways which aren't always rational from a long-term societal-benefit perspective. If reformers believe 'you get what you incentivize' then perhaps they can consider changes in the way the incentives work for insurers, to ensure that the long-term view is taken when tradeoffs are made. At the sime time, it's important to work to mitigate the unintended consequences of any reforms2. Whatever happens to health care, we need to allocate resources such that more people have access to basic coverage, not fewer. The February 2008 issue of Scientific American examined the issue in an article entitled 'Pay for What Works,' recommending revitalizing the Agency for Healthcare Research and Quality, which lost much funding and power in the mid 1990s3. The problem we face far exceed the capabilities of any single agency, but fostering best practices would certainly be a good beginning.
What You Can Do
At Elfenworks, we believe that together we can change the direction of our country, mitigate the historic levels of poverty and inequality that we are seeing, and get this country back on track. Do not underestimate the power of your efforts and your voice - they are just exactly what is needed. There are many ways in which your involvement can make a difference, and helping one person can start a ripple that sends waves of change throughout a community (and makes a difference to you personally, too). See our RIPPLE page for ideas.
1Source: Census Bureau, and Richard Wilkinson The Impact of Inequality
2The starkest example we have ever found of unintended consequences of well-meaning but poorly thought out acts was
discussed in a cover story on malaria in On Earth magazine.
Well-meaning donors gave funds to bring barrels stocked with fish to Africa. It seemed like a great idea - literally allowing people
to fish rather than giving them fish. However, the fish were not re-stocked and what remains is a breeding ground for malaria-bearing
mosquitoes. The result is more malaria, not more food.
3Scientific American, February 2008, p.32
