Health Consequences of Elections

We have become accustomed to warning labels on many commodities: health advisories on tobacco and alcohol, safety labels on many consumer products, and signage in rental cars reminding us about the danger of driving without a seat belt. Perhaps we should have warning labels on election ballots: Caution – Your candidate selection may be hazardous to your health. Now that the elections of two weeks ago are over, I’d like to reflect on what the campaigns and the results mean for health promotion, and talk about the dangers that may be ahead.

Certainly in all the elections there were some purely local issues. However, aside from the many local issues, perhaps the biggest campaign issues which seemed to turn the election were job creation and Obamacare. Both of these have implications for health promotion. Employment is impacted by health in both directions. Health is an important prerequisite for a job, and full employment is one of the most basic ways to promote good health in society. It is clear that the nation’s health status did not cause the current recession and unemployment crisis, nor will health programs contribute much to digging us out of the economic hole in which we find ourselves.

On the other hand, if we can really think about the future and not just the next business cycle, health and continuing prosperity are inextricably linked. There is great concern about the disconnect between educational performance and readiness for technical jobs of the 21st century. Certainly in disadvantaged segments of communities, malnourished kids or kids struggling with asthma are not able to be as successful in school as they might otherwise be. In addition, as our workforce gets older and the retirement system squeezes workers to stay on the job a few years longer than was common in the recent past, it will be important to help those older workers maintain wellness levels as high as possible.

The Patient Protection and Affordable Care Act of 2010 (Obamacare) is obviously a health issue, front and center. Some of the most angry rhetoric and ugly campaign ads were directed at this so-called “massive government takeover” of the “best health care system in the world. Perhaps some of the partisans actually believe that charge, but forgive me for being cynical. We have government control of most of the education system, police and fire services, the Postal Service, and libraries; government assuming these functions has not ended life as we know it. Furthermore, Medicare is an entirely government health care system, and most people think it works quite well in providing good care in a cost-effective way. Health care reform is mostly designed to help the 15% of the population with little or no access to the system now, while people with health insurance may see little if any change. When it comes to the relative quality of our health care system, compared to other nations, we don’t stack up very well. The claim that we have the best health care system in the world may be true for some consumers, but is not an accurate picture of what most people experience. A harsh reality that the opposing politicians don’t want to recognize is that even people with good insurance now may be only one serious illness away from medical bankruptcy, or at least losing their coverage. For people with good employer-provided health insurance, what would happen if they were sick enough that they could no longer perform their job. Once they lose the job, health insurance goes with it. This is a risk to a majority of citizens, not just those with no health insurance now.

The health care reform legislation passed earlier in the year includes three basic components. First, no one can be excluded from insurance coverage because of pre-existing conditions. Next, people have to be in the system; people will be required to buy health insurance if they are not already in one of the government programs (Medicare, Medicaid, Veterans’ Health Care). The only way health reform will work without dramatically increasing cost is to include everyone, including those young and healthy in the risk pool. The third component is a system to pay for all the new people brought in the system, including incentives for small businesses to provide coverage for workers. The system, which will be phased in over a number of years, represents a dramatic change in public policy, broadening the safety net so that everyone is assured a floor level of health care. While change is hard for people to accept, the current system of health care doesn’t seem worthy of fighting for, unless you are one of the few people well served as a fortunate consumer or a well-compensated provider. Those two categories are shrinking unless we accept the challenge to mold the system to one that will serve all the people.

The completed elections brought in a large number of people who are opposed to progressive change, with the belief that the free market is always better than anything organized by government. The next few months and years will be a battle to see which ideas about change prevail.