What Friedman and Sandel and Desmond (and Maine) Know About Our Nation’s Health.

Posted on | November 7, 2017 | 4 Comments

Niger and Waco

Mike Magee

We wake this morning to news that Maine voters have overrode their own governor and expanded ACA Medicaid, and Virginia voters have rejected a Trumpian appeal. As we begin to turn the corner, we need to be certain we don’t simply return to neutral but instead understand and execute progress. Health policy is the ideal catalyst.

When it comes to policy matters (whether they be related to taxes, or guns, or advertising), Canada historically has exhibited great natural instincts and a healthy dose of holistic common sense.

Consider the fact that at the end of WWII, with veterans streaming back into the country weighed down with a heavy burden of diseases, addictions, and psychiatric disabilities, Canadian leaders realized that the success of their country ultimately would depend on the health of Canadians. They wisely saw health as a human right, and realized that lack of coordinate health planning coupled with excessive free marketering would drive up cost and complexity, placing an undue burden on all of their citizens.

Compared to Canada which chose universality and simplicity, following WW II we elected to stay mired to individualism and “free enterprise” approaches reasoning that if we could beat the Nazis, we could easily beat disease, and health would thrive in its wake.

The results of this unending experiment have been singularly disappointing. Scientific progress has become unlinked from human progress. One in five dollars is now committed to a speculative Medical-Industrial Complex that continues to grow in size and appetite. And the gap between have’s and have-nots leaves a gaping hole in our national stability, optimism, and civility.

Our failures in the health sector increasingly draw comparisons to developing nations rather than to our historic developed peer nations. Fundamentally, we seem so infatuated with discovery, patents, and corporatized solutions that we manage to silently deny that health is a function primarily of social determinants.

Tom Friedman understands this. He recently focused on the struggles in Niger which came under a glaring spotlight when we lost four U.S. Special Forces in a battlefield that most Americans didn’t know existed.

Friedman wisely focused not on the losses, as tragic as they were, or even the conflict itself, but on the underlying causes. The destabilization of this region in Africa and the explosion of “economic migrants, interethnic conflicts and extremism” is tied to the ever “widening collapse of small-scale farming”. That collapse, in turn, is a function of four intersecting triggers – climate change, Saharan desertification, population explosion (Niger’s birthrate is 7.6 children per woman), and misgovernance.

In light of the above, how does America’s president respond beyond putting our soldiers at risk? By eliminating U.S. support for global contraceptive programs; by supporting climate deniers; by pushing exportation of coal to Africa; and by curbing climate research.

It would be easy to suggest that Trump is an outlier, but as we hot-tail it to “personalized medicine” and stem cell this and that (all good but speculative and of little impact on immediate population health), we way miss the forest from the public health trees.

For example, Megan Sandel and Matthew Desmond this week laid out the connection between health and housing. But was anyone but John Kasich listening?

A few facts:

1. In America, “2.8 million renting households are at risk of eviction and more than 500 000 people are homeless on any single night.”

2. “Only 1 in 4 households that qualify for housing assistance receives it… most renting households below the federal poverty line spend more than half of their income on housing costs, and 1 in 4 spends more than 70% of its income on rent and utility costs alone.”

3. “Rent-burdened families not only have less money to spend on wellness and health care but also regularly face eviction and homelessness, which further threaten their health.”

4. “Housing problems have been associated with a wide array of health complications, including lead exposure and toxic effects, asthma, and depression.”

5. “The top 5% of hospital users—overwhelmingly poor and housing insecure—are estimated to consume 50% of health care costs.”

6. “Randomized trials have found that hospital stays and emergency department visits decreased among homeless individuals after they were offered stable housing and case management.”

The authors conclusions:

Friedman: “ Nothing Trump ever says has a second paragraph. His whole shtick is just a first paragraph: Build a wall, tear up the Iran deal, tear up TPP, defeat ISIS, send troops to Niger and Afghanistan to kill terrorists, kill climate policy, kill family planning, cut taxes, raise military spending. Every box just marks an applause line he needed somewhere to get elected. Nothing connects — and we will pay for that.”

Sandel and Desmond: “ A stable home functions as a secure foundation on which to build holistic and cost-effective health care. Without this foundation, medical treatments are reduced to short-term, limited fixes that must be applied and reapplied at significant cost and insignificant health gains. Hospitals and health systems can and must do better in investing in homes for health, for both patients and the broader community.”

And Kasich, to a major GOP donor who challenged his support of Medicaid expansion in Ohio at a Koch brothers conference: “I don’t know about you, lady, but when I get to the pearly gates, I’m going to have an answer for what I’ve done for the poor.”

Comments

4 Responses to “What Friedman and Sandel and Desmond (and Maine) Know About Our Nation’s Health.”

Chuck Fahey
November 8th, 2017 @ 9:00 am

Thanks Mike,
An excellent, insightful commentary,
Peace and all good things,
Mike Magee
November 8th, 2017 @ 9:11 am

Thanks, Chuck! Have a great day!
Tom Linden
November 9th, 2017 @ 9:13 am

Well put, Mike.
Mike Magee
November 9th, 2017 @ 9:49 am

Thanks, Tom! That means a lot coming from you! Best, Mike