Thoughts on Health Care Reform

As boxes and arrows and words scribbled in chalk rapidly took over the board, I was once again struck by the same uneasiness I had been feeling for a while whenever the topic of health care reform came up: will we be changing anything at all?

We were drawing a diagnostic tree in class, pinpointing potential causes behind the discrepancy in what the U.S. pays per capita and our health outcomes. Words were scrawled hastily across the board as we brainstormed – lack of fee for service, fragmented financing, lack of access. I want these words to be huge, bright, flashing neon signs in the face of U.S. citizens. But they are getting buried – buried in rhetoric, in scare tactics, in sensational statements instead of an articulation of the facts.

The fundamental misalignment of incentives at every stage of the healthcare system – specialists being paid far more than general physicians, physicians being paid for quantity instead of quality, patients not seeing the true costs of procedures and medications due to insurance coverage – is not what the health care debate seems to be about. The absurdity of inequalities in health – by socioeconomic status and by race, among other things – is not what the health care debate seems to be about. The structural, environmental, and societal factors that combine to make us unhealthy are not what the health care debate seems to be out.

Insuring everyone is important, but we must consider – what does having insurance mean? Having insurance doesn’t change the fact that some people can’t get out of their sprawling suburbs without a car. Having insurance doesn’t change the fact that some neighborhoods are incredibly unsafe. Having insurance doesn’t change the fact that some people’s nearest hospital is miles and miles away, understaffed, and underfunded.

While I am incredibly, incredibly grateful to all those who are working to change our system for the better – including so many here at our school, as well as President Obama and his administration – if the health care debate thus far is indication of what the health care bill that eventually passes will look like…I have to wonder, will we be changing anything at all?

[Disclaimer: I am not as pessimistic as all that makes me sound – I firmly believe that public health can improve things, and I do think health care reform will change some things (and that having health insurance changes some things!), just not enough things or to an adequate extent. And I’m not at all arguing against taking quick action on health care reform. Best case scenario – the voices of public health experts and others get heard, and we get a bill that, though far from perfect, actually addresses some fundamental problems and affects some real change. Some of the bills under consideration now do address at least some fundamental issues, despite the lack of focus on these issues in the debate, and for that I am very grateful! Worst case scenario (assuming a bill passes) - a bill, any bill, would serve as a starting point – if we can change something about health care, it is no longer untouchable, and hopefully iterations in the future will bring us closer to the kind of health outcomes our country should have. ]

Vinu Ilakkuvan
ScM Candidate 2010
Society, Human Development, and Health