Democratic platform on health: It's not just the uninsured*

For the first time since healthcare has been written into political platforms, people are proposing ideas that look beyond the bottom line issue of how to deal with the problem of the uninsured. The new U.S. Census Bureau national statistics on health insurance are due out Aug. 26, and many experts believe they will show an increase over last year's 47 million uninsured Americans. (*In fact, the U.S. Census Bureau's figures released today, as reported in the Los Angeles Times, showed a drop in the number of uninsured, to 45.7 million, primarily due to an expansion of government-provided services to children.)

That this year's Democratic platform calls for affordable coverage for all Americans is no surprise. But it also calls for a new emphasis within the healthcare system on prevention and wellness.

"We need to promote healthy lifestyles and disease prevention and management especially with health promotion programs at work and physical education in schools. All Americans should be empowered to promote wellness and have access to preventive services to impede the development of costly chronic conditions such as obesity, diabetes, heart disease and hypertension. Chronic care and behavioral health management should be assured for all Americans who require care coordination. This includes assistance for those recovering from traumatic, life-altering injuries and illnesses as well as those with mental health and substance use disorders. We should promote additional tobacco and substance abuse prevention."

The United States has epidemics of chronic diseases that are largely preventable, including diabetes, heart disease and obesity. "If we're going to deal with the affordability of healthcare, we've got to do a lot more about preventing diseases," says Dr. Ken Thorpe, professor of health policy at Emory University and executive director of the Partnership to Fight Chronic Disease. "About 75% of healthcare spending is associated with chronic disease. This has percolated up to become a center stage issue."

-- Susan Brink

Comments

[Paul E. Jarris, MD, MBA]

. As State and territorial public health officials we have been engaged with the candidates and campaign staff since early in the year in an attempt to insert prevention and public health into national health policy. We are pleased that the efforts of many organizations are bearing fruit. Thank you for reporting on the prevention and wellness components of the Democratic Platform.

It is important to note that prevention and wellness go far beyond just health care. Health is not just a matter of the cost of health insurance and access to health care. Health is achieved largely outside of the doctor’s office when we have access to healthy foods and safe communities for physical activity and social interaction. These factors are the responsibility of all Americans as individuals and organizations in the public and private sector. For this reason, major corporations and business groups have joined with public health in forming “The Healthiest Nation Alliance. “ www.healthiestnation.org

Our goal is “Health System Transformation” rather than the narrower “Health Care Transformation”. The distinction is critical. A Health System includes both the public health and health care systems. Our objective, along with our sister public health agencies and many national groups who are part of the Healthiest Nation Alliance, is nothing less than transforming the United States into the Healthiest Nation in the world. After all, the U.S. spends more money than any other nation on health care – so why is it we rank at the bottom of the industrialized nations in the health status of our people?

Becoming the Healthiest Nation will require public private partnerships at all levels of government and across the spectrum of public and private entities. It will require us to evaluate the health impact of all public policy as well as business decisions. Businesses which develop policies and programs to promote the health and wellness of their employees and communities do save on health care costs, but equally important they realize economic benefit from improved productivity, and minimization of absenteeism, presenteeism, workers compensation, disability and retiree benefit costs. Communities which create and maintain a health promoting environment are better able to attract employers seeking a healthy and productive workforce. Health is a critical business and community resource. We must promote and sustain it, not simply repair it when damaged in a hostile environment.

The time has come for America to ask the right question: How do we become the healthiest nation in the world?

[Sarah Mashburn]

For the first time, the Democratic platform also addresses another important health care issue: how our country pays for long-term care. Here is an excerpt from the platform:

"Seniors and people with disabilities should have access to quality affordable long-term care services, and those services should be readily available at home and in the community. Americans should not be forced to choose between getting care and living independent and productive lives."

To me, that last sentence says it all. Health care reform cannot be complete without addressing how we can make it affordable to care for millions of older adults in the place they call home.

[David Kottcamp]

I don't know why people keep coming back to this number that the Census Bureau provides; the way they compute it, makes it virtually meaningless in trying to identify what ails health care in the US.

For a more detailed discussion on what this 47 million uninsured means, go to:

http://playingdevilsadvocate.com