Insecurity vs. equity: what's driving health reform in the U.S. (and post-script on class and health)

While we Americans might personify a kinder, gentler nation if we believed in health equity, it's really health insecurity that's driving current health reform efforts in the U.S.

The lead op-ed in the 1st October Financial Times (FT) editorial page forecasts, "Reform is coming to US healthcare." The column discusses last week's Congressional vote on the state children's health insurance program (S-CHIP). The FT editors then talk about how all of the Democratic presidential candidates have plans for, at a minimum, near-universal health care, an issue that was "considered toxic for the (Democratic) party" just a few years ago.

Although the paper is published across the Pond, they have captured the essence of the current American gut-feelings about health reform: it's the health insecurity, stupid! To quote the FT:

"Insecurity more than equity in the ordinary sense is the issue."

Spot-on, FT editors!

Now here's where I nearly fell out of my chair. I've been a regular FT reader since living in London in the mid-1980s. I realize that the salmon pink-hued paper, emanating since 1888 from the City of London's financial center, is no proponent of public sector programs or entitlements. However, the FT has crossed over to the other side when it asserts, "Universal coverage is feasible, desirable and overdue."

The op-ed goes on to correctly mention (but not solve the problem of) the big C: costs. They also say that our employer-sponsored system continues to perpetuate the illusion that, for the majority of Americans, health care is cheap.

Of course, health care isn't cheap. If universal coverage is to be sustainable, the focus must be on how to achieve coverage for all Americans through a basic benefit plan while making consumers fiscally accountable above that basic level. Equity plus fiscal responsibility (coupled with taking better care of ourselves as a nation through prevention and health promotion) is a practical guiding equation.

Health Populi's Hot Points: The FT plays the role of one of the publishing world's fiscally conservative thought leaders. When this global "stockbroker's Bible" waxes lyrically on the merits of universal healthcare in the U.S., it's a sign that Big Business has begun to embrace the universal health care concept. That isn't to say that U.S.-based conservative think tanks are embracing the concept of universal health care. But the FT, which provides global thought leadership, well comprehends that employer-based health insurance creates an intractable, burdensome global disadvantage for American business. And it's freely moving markets that the FT really loves most.

HP Post-script: After posting this blog, I read Maggie Mahar's analysis of Dr. Stephen Schroeder's commentary in New England Journal of Medicine which focuses on class and health. It is posted today on Merrill Goozner's blog. It is well worth your time to consider. Here's a snippet of Dr. Schroeder's analysis: "One reason the United States does poorly in international health comparisons may be that we value entrepreneurialism over egalitarianism,” Schroeder notes. “Our willingness to tolerate large gaps in income, total wealth, educational quality, and housing has unintended health consequences. Until we are willing to confront this reality, our performance on measures of health will suffer.”