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Momma said wonk you out

THE PRIMACY OF PUBLIC HEALTH.

Reading Neal Halfon's article on "The Primacy of Prevention" reminded me of a point that I don't make enough. Health reform, which is what we mainly talk about, is about economic security more than it's about health improvement. It's about ensuring people don't go bankrupt when they need care, and ensuring the country doesn't go bankrupt in 30 years beneath the burden of health costs.

Conversely, the real gains to be made in population-health (the term researchers use for the aggregate health of the country) will come from public-health efforts. That's a broad category. It can include everything from vaccinations to stripping lead from walls to encouraging better nutrition to making educational interventions. A better integrated health system would encourage this as it would make it far easier to reach the relevant populations, but it would not, on its own, radically change the health outcomes of anyone but the uninsured or severely underinsured, and it would not necessarily be reliant on individual medical care. Rather, it'll probably require broader policy changes that make it easier for whole populations to live healthier lives almost without meaning to. That means more walkable, bikable cities. It means less pollution and lead in the walls and water. It means more access to fresh, affordable, fruits and vegetables in poor and urban areas. It means food subsidies targeted towards healthy foods rather than foods with powerful interest groups. It means more anti-smoking programs.

It means, in other words, a lot of stuff that's not very dramatic and that doesn't generally have an engaged constituency behind it. With health insurance, there are a lot of folks who have lost everything, a lot of businesses that can't afford the costs, a lot of groups impacted by the economics and willing to advocate for their interests. That's a huge political advantage. These programs are important, but they're not natural political flashpoints. It's a problem.



COMMENTS

pollution AND lead...shit, that's bad

"It means, in other words, a lot of stuff that's not very dramatic and that doesn't generally have an engaged constituency behind it. With health insurance, there are a lot of folks who have lost everything, a lot of businesses that can't afford the costs, a lot of groups impacted by the economics and willing to advocate for their interests. That's a huge political advantage. These programs are important, but they're not natural political flashpoints. It's a problem."

But, of course, a universal system would create incentives to deal with the unsexy issues under the same protective political roof.

But Ezra used to know this, back before he sold out to support the candidate bashing a workable universal healthcare system.

Now Ezra will spend the next twenty years bitching about our inability to institute rational healthcare delivery innovations, always ignoring that it was he, Ezra Klein, who proved a craven coward back when he could've made a difference.

It's all about Ezra's career for Ezra. Healthcare is just schtick to him.

I would like to know exactly how making people live longer healthier lives will save money? This sounds counter-intuitive but the Slate found that the obese who do live shorter lives cost less in the long run.
http://www.slate.com/id/2184475/

I may be wrong but is it not the old (80+) who cost the most to look after and won't creating more people who live 80+ years cost more health care dollars. Add to that the other costs of an increasing ratio of dependents to workers.

Morality aside, I don't think the universal health care advocates have convincingly demonstrated preventative care costs less. And merely comparing America to other countries with higher life expectancies and lower costs doesn't really make sense since they are essentially placing a cap on costs and then distributing care (which is different than Ezra's proposal).

Man I hate trolls. Shoo, fly.

And lead abatement, lead abatement, lead abatement. You just can't say it enough.

Lead abatement.

Indeed, much trollery around here. Shoo, shoo.

Back to Ezra's post, there is one interest group, that, given the chance will advocate for healthier living, and that's parents. Up to now, when confronted with unsafe environments, most parents just moved their kids to the suburbs, if they could, bought better food, etc.--whole industries revolve around child safety. But we've begun to reach the limits of the safety we can purchase; organic milk only reduces, not eliminates, your kid's exposure to pesticides because that shit is everywhere. Lead-painted toys, mercury in fish, asthma rates, autism rates*, obesity rates, loss of green space to play in--the effects on our kids keep piling up.

There's a lot of low-level anxiety for parents, a sort of underground knowledge that all this toxic stuff around us is affecting our kids as well as ourselves--the FDA has started to respond to pressure to look into Bisphenol-A in plastics, for example (though they are still taking industry's side thanks to Republican appointments). I think, quite frankly, that there is quite a lot of potential for demanding change, it's just that most people have felt so hopeless and helpless in the face of war and Republican shenanigans. But the pressure keeps building, and if we take the heavy hand of the Republican know-nothings away...well I'm hopeful.

*I know the research on environmental causes isn't conclusive, but that doesn't mean parents don't worry about it.

“It's about ensuring people don't go bankrupt when they need care, and ensuring the country doesn't go bankrupt in 30 years beneath the burden of health costs.”

This is quit the about face form everything you have said in the past 12 months. The dismissal of CDHP, talk about our infant mortality compared to every other country, and pandering for progressive reform plans have never addressed this issue. Could you link to any post of your where you discussed insurance in this pure of form?

This is the exact function insurance companies should be playing in our system but government has refused to let them. Mandated benefits and small group purchasing pools are not insurance.

If you where truly serious about what you just said you would have a post up already outlining how high deductible health plans and passing the association health plan bill that has been on congress for 10 years could accomplish this in a couple years with minimal cost to tax payers. If small employers and individuals could join together to purchase stop-loss like Union Taft Hartley plans do this could be accomplished before the ink dries.

Why are progressives blocking the AHP bill Ezra? Why do you talk about the need for true insurance out of one side of your mouth then advocate insurance plans with low deductibles and out of pocket cost out the other side?

How can you turn a problem as simple as giving everyone a catastrophic insurance policy into a trillion dollar government take over?

After a year of ignorant posts on healthcare you’re either finally realizing where the real problems are or you’re so clueless about healthcare you don’t even know your contradicting yourself.

The congressional BCBS plan for all is not insurance, it’s financing healthcare. Get your sound bites in order.

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Learn How You Can Add 10-20 More Years To Your Life With the New Discoveries in Medical Science...
You can find out more about the new "How to be live to a Hundred"
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Have You Ever Wondered What It Might Be Like To Find The Long Lost Fountain Of Youth?

At Last, the Ultimate Secrets of "How to be live to a Hundred" Finally Revealed!

Learn How You Can Add 10-20 More Years To Your Life With the New Discoveries in Medical Science...
You can find out more about the new "How to be live to a Hundred"
http://www.livehundred.ultimate-energi.com

"you may say I'm a dreamer, but I'm not the only one."

Ditto for me:

"But, of course, a universal system would create incentives to deal with the unsexy issues under the same protective political roof.

But Ezra used to know this, back before he sold out to support the candidate bashing a workable universal healthcare system.

Now Ezra will spend the next twenty years bitching about our inability to institute rational healthcare delivery innovations, always ignoring that it was he, Ezra Klein, who proved a craven coward back when he could've made a difference.

It's all about Ezra's career for Ezra. Healthcare is just schtick to him."
-------

"I am a patient not a profit"

http://www.guaranteedhealthcare.org

National Day of Protest Against Health Insurance Corporations: June 19th!


38,000 Health Insurance Executives are coming to San Francisco. Join patients, nurses, doctors, and Americans of every stripe protesting in memory of the countless victims of the insurance industry. Join us and bring friends!

DOESN'T EVERYONE DESERVE HEALTHCARE?

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About Ezra Klein

Ezra Klein is an associate editor at The American Prospect. An archive of his articles for The American Prospect can be found here.

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