Over the past few weeks in my pediatrics clinic in southeast Washington DC, as I have wished Merry Christmas to my patients and families, I have pondered about the Three Wise Men who paid homage to Jesus, an infant born in poverty. As we all know, they traveled a great distance and came bearing meaningful gifts of gold, frankincense, and myrrh because of their belief in the promise of a child. The scripture has made me ask the question, are the self-proclaimed wise men of today giving the best of themselves for our children, especially those born in poverty? What would be the modern equivalents of gold, frankincense, and myrrh today?
The meaning of gold is obvious, and to me its modern equivalent is funding for programs and assistance that address the needs of our country’s children. It was tragic to watch some members of Congress squabble over how to fund unemployment insurance (which was a part of the bickering over the payroll tax cut), and other critical elements of the social safety net. Unemployment insurance (the average UI check is about $300 per week) provides vital assistance to 3.1 million Americans struggling to make ends meet, even if only temporarily. Maintaining this poverty-reducing support should not be as difficult as Congress makes it out to be.
Together the Child Tax Credit and the Earned Income Tax Credit (EITC) lift more children out of poverty than any other program. The American Recovery and Reinvestment Act in 2009 made improvements to the Child Tax Credit, providing up to $1,433 more for families earning wages at or just above the minimum wage. Similarly, the EITC was expanded for married couples and families with three or more children. These provisions, combined with others in ARRA, kept 2.4 million children out of poverty, but the future of these policies is uncertain after 2012.
Right now there are many who question whether we can afford to build upon these efforts and to develop new innovations in reducing poverty. My argument is that we cannot afford not to. Every year, child poverty costs our economy $500 billion dollars in health care expenses, lost productivity, and criminal justice. Parting with the “gold” for unemployment insurance, EITC, housing, and TANF is easier when it is rightly seen as an investment – in both our financial and our moral future.
To understand the significance of frankincense, it helps to know that it is a resin once used for medicinal purposes: healing wounds, treating arthritis, repelling mosquitoes, etc. It was (and still is) a symbol of health and life to many people. As a pediatrician, I feel the modern corollary to frankincense could be Medicaid, which takes care of multiple health needs for millions. Nearly all of my patients in southeast DC are enrolled in the program, which allows them to get regular check-ups, dental care, eye exams, mental health care, and much more. Today, Medicaid and the Children’s Health Insurance Program (CHIP) is the nation’s largest health insurance program for children, providing access to health care to 38 million children – that’s 1 in 3 – across the country.
Unfortunately, there are still 8 million uninsured children in our country, but 2/3 of them are eligible for Medicaid/CHIP. Sadly, certain members of Congress and other Presidential candidates want to convert Medicaid into a block grant program or apply unfair spending caps to it. These measures would allow the states the so-called “flexibility” of denying more children access to health care. Such ill-advised policies ignore Medicaid’s proven fiscal efficiency: costs of health care per patient in Medicaid have grown slower than costs per patient with private insurance: 4.6 percent versus 7.7 percent per year. Children make up half of all Medicaid recipients, but account for just a quarter of the program's total costs. Clearly, this program, even with its imperfections, should be valued as a gift. Rather than finding ways of undermining Medicaid and CHIP, our political leaders must find ways to support this lifeline to children, the elderly, and the disabled.
The Three Wise Men’s last gift, myrrh, is another resin, once used for mummification in ancient Egypt, for medicinal purposes, and it still has spiritual value to many cultures. It was a gift of faith in what Baby Jesus would grow to be and do for mankind. Such a gift does not require a modern equivalent, but I do question whether our society really demonstrates its faith in children. The above threats to their health care and their basic financial support reflect a commitment to maintaining spreadsheets and to political arithmetic, regardless of the costs to children in poverty – now almost 6 million, or 1 in 5. As a percent of total federal spending, investments in children fell to 8.4% in 2011. The fact that the policies and programs with proven service to children are consistently the first items on the budget chopping block is an indication of how shallow our faith really is.
If our political leaders had more faith in our children’s capabilities and aspirations, then they would open more doors than just the janitor’s closet when it came to creating job and career opportunities. Doing the hard work of providing health care, education, housing, and opportunity for children requires not just tough decisions over limited resources, but also a solid faith in our children’s potential. Such a commitment would lead us to readily provide our children with the best of ourselves.
There are obviously other interpretations on the significance of the Three Wise Men’s gifts, and I recognize how my experience as a pediatrician caring for children in poverty influences my perspective. However, regardless of one’s beliefs about this Christmas story, we find that when the Three Wise Men paid homage to an infant born in humble circumstances, their faith drove them to take action, to go the distance, and to provide resources. That is a timeless example for all of us to follow for all of our children.
Friday, December 23, 2011
Wednesday, July 22, 2009
A Public Option Is Not the Boogeyman
As a pediatrician reviewing objections to the inclusion of a public insurance plan in health reform, I can’t help but think of a few of my young patients who have suffered from nightmares. Their parents brought them to clinic, concerned about the quality of their sleep, and the harm these bad dreams were having on their psyche. There are no quick fixes to cure nightmares, but they can be treated, and the process has special relevance to the current health reform debate over a public insurance plan.
First, a person with nightmares needs to be reassured that what she saw and heard was not real. There is no monster under the bed. A similar point needs to be made about the misconceptions around a public insurance plan. One of the biggest fears is that it will put the private sector of health insurance out of business. This is simply not true. We have examples of public agencies and private businesses offering similar services to the American people, and both exist side by side. FedEx, UPS, and DHL are not at risk of disappearing because the US Post Office can also send letters and ship packages for the average American to any destination around the world. A public plan for health insurance will have lower administrative costs than plans offered by the private health insurance cartels, which will have to ask, answer, and act on the question: “Are we getting the best bang for the buck?”
Protectors of the private health insurance industry ask why any American would choose a private plan when they could go with a cheaper public option. Under this line of reasoning, none of us would be driving a Mercedes-Benz when a Toyota Camry can get us from place to place. In a CBS News poll done last week, over 900 Americans were asked the following:
"Suppose the federal government offered a public health care plan that anyone could join at any age. What would you probably do? 1. I'd definitely join the plan. 2. I'd probably consider the plan, and compare it against my private insurance options. 3. I'd probably consider the plan only if I had no other insurance options. OR, 4. I'd probably never join the plan."
Here are the results:
Coming back to the subject of nightmares (or maybe we never left it), to help a patient, her family must be honest about the real stresses happening in her life. Family members who are in denial about a patient’s problems, or who block resolving those problems because of an unwillingness to change, make the already difficult recovery process that much harder. In the health reform debate, critics of the public insurance plan claim that our flawed system is better than introducing any government efforts, wherein a public option would allow government bureaucrats to ration care.
Not only is this argument wrong, but the American people should also remember that the corporate bureaucrats in the private health insurance companies always ration care, first by income and then by illness. Screening patients for pre-existing conditions might become a thing of the past with some of the legislation under construction, but thousands of Americans have been the victims of rescissions, which the health insurance companies told Congress under oath they have no intention of even limiting, much less ending. The opponents of a public option must think sick Americans are doing just fine as they gamble their health and their family’s finances in Russian roulette games against the private health insurance cartels.
Some members of Congress are also spreading the fear that a public option would disrupt quality and research in medicine, pharmaceuticals, and biotechnology. But if that were really the case, then how do we make sense of the Veterans Health Administration? The VHA cares for over 5 million Americans (without rationing), and the overwhelming majority of them have been happier than private health insurance customers with the quality of their health care. The American Customer Satisfaction Index has proven it year after year. Furthermore, thousands of VHA hospitals partner with academic medical centers, contributing to cutting edge research for the betterment of all Americans. These unsung success stories can serve as a wake up call to those who are unaware of the possible benefits of a public option.
A public plan for health insurance is not a panacea, but it is more than a band-aid in reforming American health care. 18,000 Americans die every year because of a lack of health insurance. A public option is thus a vital first step, and it is supported by over 70% of Americans. We should applaud President Obama and many members of Congress for their efforts, but they cannot go it alone. It is time for other Senators and Representatives to support that work. Our problems will not go away with a pat on the head and a glass of water.
First, a person with nightmares needs to be reassured that what she saw and heard was not real. There is no monster under the bed. A similar point needs to be made about the misconceptions around a public insurance plan. One of the biggest fears is that it will put the private sector of health insurance out of business. This is simply not true. We have examples of public agencies and private businesses offering similar services to the American people, and both exist side by side. FedEx, UPS, and DHL are not at risk of disappearing because the US Post Office can also send letters and ship packages for the average American to any destination around the world. A public plan for health insurance will have lower administrative costs than plans offered by the private health insurance cartels, which will have to ask, answer, and act on the question: “Are we getting the best bang for the buck?”
Protectors of the private health insurance industry ask why any American would choose a private plan when they could go with a cheaper public option. Under this line of reasoning, none of us would be driving a Mercedes-Benz when a Toyota Camry can get us from place to place. In a CBS News poll done last week, over 900 Americans were asked the following:
"Suppose the federal government offered a public health care plan that anyone could join at any age. What would you probably do? 1. I'd definitely join the plan. 2. I'd probably consider the plan, and compare it against my private insurance options. 3. I'd probably consider the plan only if I had no other insurance options. OR, 4. I'd probably never join the plan."
Here are the results:
- Definitely Join: 12%
- Compare against private options: 43%
- Consider only if no other options: 31%
- Probably never join: 11%
- Unsure: 3%
Coming back to the subject of nightmares (or maybe we never left it), to help a patient, her family must be honest about the real stresses happening in her life. Family members who are in denial about a patient’s problems, or who block resolving those problems because of an unwillingness to change, make the already difficult recovery process that much harder. In the health reform debate, critics of the public insurance plan claim that our flawed system is better than introducing any government efforts, wherein a public option would allow government bureaucrats to ration care.
Not only is this argument wrong, but the American people should also remember that the corporate bureaucrats in the private health insurance companies always ration care, first by income and then by illness. Screening patients for pre-existing conditions might become a thing of the past with some of the legislation under construction, but thousands of Americans have been the victims of rescissions, which the health insurance companies told Congress under oath they have no intention of even limiting, much less ending. The opponents of a public option must think sick Americans are doing just fine as they gamble their health and their family’s finances in Russian roulette games against the private health insurance cartels.
Some members of Congress are also spreading the fear that a public option would disrupt quality and research in medicine, pharmaceuticals, and biotechnology. But if that were really the case, then how do we make sense of the Veterans Health Administration? The VHA cares for over 5 million Americans (without rationing), and the overwhelming majority of them have been happier than private health insurance customers with the quality of their health care. The American Customer Satisfaction Index has proven it year after year. Furthermore, thousands of VHA hospitals partner with academic medical centers, contributing to cutting edge research for the betterment of all Americans. These unsung success stories can serve as a wake up call to those who are unaware of the possible benefits of a public option.
A public plan for health insurance is not a panacea, but it is more than a band-aid in reforming American health care. 18,000 Americans die every year because of a lack of health insurance. A public option is thus a vital first step, and it is supported by over 70% of Americans. We should applaud President Obama and many members of Congress for their efforts, but they cannot go it alone. It is time for other Senators and Representatives to support that work. Our problems will not go away with a pat on the head and a glass of water.
Welcome
First off, thank you for coming and checking out my blog. My friends and family already know most of my story, but to put things in a nutshell, I'm a pediatrician trained at UCLA, and I just finished the Commonwealth Fund Harvard University Fellowship in Minority Health Policy. For the last few months, I have been looking for work in Washington DC as a health policy adviser on the Hill or with a think tank. Though I did not have a job upon graduating from Harvard, I decided to move to DC anyway, and continue my search closer to where the action is. The search goes on, and I will update this blog as things develop.
After several people encouraged me to write and share my thoughts on the current health reform debate, I decided to give blogging a try. I don't have all the right answers, and my opinions are obviously up for debate, but I hope this blog can contribute to the dialog in some way, even if it's only amongst my family and friends. Of course, this puts the pressure on readers to comment, and I welcome discussions and disagreements.
I will do my best to base my writing on evidence when possible, and will share links to that evidence. Please feel free to do the same with your comments. It will keep us honest in this marketplace of ideas.
As a disclaimer, I take responsibility for the opinions I express here. Like I said, I'll do my best to base those opinions on evidence, but I don't mean to speak for institutions or organizations I belong to or cite.
Finally, I want to thank my family for pushing me to write, and I thank you, the reader, in advance for your time, patience, and participation.
After several people encouraged me to write and share my thoughts on the current health reform debate, I decided to give blogging a try. I don't have all the right answers, and my opinions are obviously up for debate, but I hope this blog can contribute to the dialog in some way, even if it's only amongst my family and friends. Of course, this puts the pressure on readers to comment, and I welcome discussions and disagreements.
I will do my best to base my writing on evidence when possible, and will share links to that evidence. Please feel free to do the same with your comments. It will keep us honest in this marketplace of ideas.
As a disclaimer, I take responsibility for the opinions I express here. Like I said, I'll do my best to base those opinions on evidence, but I don't mean to speak for institutions or organizations I belong to or cite.
Finally, I want to thank my family for pushing me to write, and I thank you, the reader, in advance for your time, patience, and participation.
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