The Charleston Gazette Story:Dan Kurland
Saturday, in 100 cities across the country, thousands of people will march to “bridge the gap” in health care. From the Golden Gate Bridge to Brooklyn Bridge, people are banding together in a call for quality, affordable health care for all.
Mention a gap in health care, and people immediately think of insurance. Without doubt, too many West Virginians lack insurance, and increasing numbers are underinsured.
Focus on insurance, however, may not be the best approach toward assuring comprehensive, affordable health care.
Health insurance today is a mix of disconnected programs. It currently includes individual plans, a variety of employer-based plans, need-based public plans (Medicaid) and contribution-based public plans (Medicare), and even charity and uncompensated care as de facto “insurance” for the uninsured.
Health insurance is funded by a haphazard mix of payroll and income taxes, employer and individual contributions, as well as premiums and co-pays.
Current proposals for extending private insurance (e.g., medical savings accounts, drug discount cards) generally offer limited protection against the inherent greed of the marketplace. Proposals for the expansion of public insurance programs (e.g., CHIP, Medicaid) must compete in a tight market with other federal and state funding needs.
Universal, affordable, quality care requires a more focused and comprehensive revenue stream than such a panoply of insurance programs can provide. Even more to the point, a health-care model based on insuring against the cost of infrequent services simply no longer meets the need for ongoing health promotion, disease management, and illness prevention activities that ultimately affect the overall cost of the system. Health insurance directly addresses the cost of health care, but does not necessarily guarantee access to physicians or hospital care.
If insurance is not the best model, what is? Education and public safety suggest an alternative. Universal education meets both individual and societal needs. Public education fosters both civic responsibility and economic development. Similarly, police protection and public safety assure order for both the individual and society as a whole.
Health care shares these dual perspectives. It is both essential for individual well-being and critical to the stability and development of the community. Adequate, affordable health care is not simply a health issue. It is, above all, an investment in the human infrastructure of the society.
Yet, unlike public safety and education, health care is left to market forces. All too many must struggle to devise a personal safety net. And while health care is regulated by the government, government’s interests often lie with the health of the health industry (pharmaceutical manufacturers, hospitals, insurance companies), not the health of its citizens.
The ideas expressed above are not new. This past session, the Legislature passed a resolution declaring “that health care … be considered a primary social benefit, similar to education and police protection, essential for community stability and economic development.” The resolution goes on to assert “the goal of the state to provide all West Virginians with comprehensive, quality, affordable health care.” A subcommittee in the interim session is charged with determining the most appropriate mechanisms for reaching that goal.
Admittedly, some gaps in health-care coverage can be addressed through incremental changes in existing insurance programs. Such efforts might stay the tide of rising expenses and diminished care for a while. But they would do little to assure a stable system into the future.
A lasting solution must simultaneously address gaps in health funding, access and delivery, and lifestyle decisions that affect individual health status. It must address the ever-expanding use of expensive technology, administrative waste, and the high cost of end-of-life care.
We must re-examine the underlying nature of how we, as a society, choose to provide, or deny, health care to our community.
Kurland is a Charleston artist and health action coordinator of Covenant House.
