Fort Report: Life Expectancy
I received a note from Scott, a farmer from Nebraska. It is a straightforward letter, Nebraska like. I’ll just show you basically what he wrote:
My health care is $23,000 a year with a $20,000 deductable.
I have $46,000 in property taxes (on a relatively small farm.)
I’m paying $24,000 in state and federal taxes.
Corn is $3.09 a bushel.
This. Doesn’t. Work.
Scott is right. This is unsustainable. Such skyrocketing costs do not work for small business owners, for farmers, for many Americans facing the assault of unsustainable premium increases.
Catherine also wrote to me. She is a retired nurse. Due to preexisting conditions, she could not previously afford health care insurance. Now through subsidies she can. Catherine is also right.
Health care is complicated. To better assess the challenges, we have to segment the problem into digestible pieces. One group of people is being helped due to significant subsidies based upon their income. They are fearful of any change that would disrupt their care. At the same time, another group of people is left twisting in the wind. Although they are working, they do not qualify for Medicaid or subsidies, and their premiums are bigger than their house and car notes combined. They can’t make it. No wonder there is so much anger.
Multiple ideas have emerged about restoring a vibrant insurance market that is affordable, competitive, and protective. A first order priority is to ensure no one is left behind. At the same time, those who have the greatest financial pain deserve another system. We will see progress on these fronts in the coming weeks and months.
As all of this policy dynamic unfolds, there is a topic which remains unaddressed. For a certain segment of the population, life expectancy is going down. We spend more on health care than ever before, and yet what are we achieving? In effect, the entire health care debate revolves around financing, drugs, and procedures; thus the entire debate is incomplete. Whether health care policy is run by big government, whether it is run by big business, or whether a new innovative system emerges that rightfully combines the best aspects of certain public subsidy and a truly vibrant market system, the issue is the same: we are still only talking about how to pay for drugs and procedures. Health is much more.
Better health demands a comprehensive concept of wellbeing, one that is more complex than standard medical practice. Wellbeing is nurtured in community. Access to good care, stable relationships, and a high quality of life are all central to this concept. Interestingly, some of the poorest people in America, with limited access to resources and health care, have some of the best health outcomes. This reality rises organically from intact community ecosystems that enable persons the freedom of commitment and interdependency.
This moment of government transition provides a chance to rethink the equation, giving people where they live the security of affordable health care insurance while also nurturing a greater sense of place, purpose, and participation, so that they can actualize community solutions. I’m working on a new public policy concept called the Community Savings Account to facilitate and reward social health innovation.
Restoring a properly functioning and affordable health care system—with a renewed focus on understanding the fullness of wellbeing—could create an exceptional outcome at a tough moment. Then both Scott and Catherine win.