The Assault on Social Policy by William Roth

Author:William Roth
Language: eng
Format: epub
Tags: -
Publisher: Columbia University Press
Published: 2014-05-19T00:00:00+00:00

CHAPTER

Health

HEALTH CARE and its reform constitute one of the most complicated yet at the same time critical social policy issues facing the United States today. To begin, we acknowledge that, although everyone wants it, health is difficult to define. Most hold it as something more than the absence of disease. The United States spends some 17 percent of its gross domestic product attempting to achieve it. In 2010 the combination of Medicare, Medicaid, and related children’s health care accounted for more than 20 percent of all federal spending—more than Social Security or defense. Medicare costs approximated 521 billion dollars and are expected to grow at an annual rate of 5.6 percent through 2021. The number of beneficiaries is expected to grow from 38.5 million people to 64.9 million during the same time period (2010–2021).1 There are various proxies for health—for example, life expectancy and infant mortality rate. The location of disease within our bodies is surprisingly new, and the discovery of causes for diseases even newer.2 Newest of all is the ability to do something about disease, even to cure it.

George Washington was not killed by his serious infectious disease but by the heroic therapy he received: bleeding. If Stalin had to be a bit imprudent to fear doctors, Rousseau’s injunction to avoid them was, at least in retrospect, altogether sane. With the human genome project ahead of schedule, medicine has forged a pact of critical importance, first with careful systematic observation and later, increasingly, with science. All this is to say that medicine has changed, is currently changing, and will change in the future. At least for now and in the future, we can substitute the word “progress” for “change.”

Yet medical progress and social change diverge. Barring significant changes in society, they will diverge further. As social change increasingly tilts society toward the benefits of haves, the divergence between medical and social change will not be to the benefit of have-nots. The patterns exist today, with whites living almost a decade longer than African Americans, the United States being a world mecca for the best medicine for the rich, slightly more than fifty million people in the United States uninsured, poor areas being poorly served, developing nations plagued by diseases long banished from developed nations, and so on.

An OECD report in 2011 indicated that the United States spends more on health care than any other OECD country. Public and private costs average $7,538 per person, which is more than two times the OECD average.3 Even though we spend over 17 percent of the GDP for health care, few of us behave as if we believe health is that important. For example, our lives are likely to be too sedentary, with sporadic, even isometric, exercise. We use too many drugs too often, including sugar, nicotine, and alcohol. Our diets have too much fat. (The use of fats in fast foods fattens not only us but the profits of corporations.) According to the American Heart Association, in 2012 some forty-five million Americans were considered obese.

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