After storms, time for permanent health-care fix

 

Reprinted from The Journal News    

Sunday October 23, 2006

COMMUNITY VIEWS

Opinion

By Georganne Chapin and Karen Pennar

It shouldn't take a tragedy to show the failings of social policy, but now that Katrina and Rita have done so, it's time to seize the moment and press for reform. The logical place to start: health care.

Statistics for Louisiana and Mississippi, ranked 50th and 49th, respectively, in overall state health rankings in 2004, show in stark relief the health problems that plague so many of the poor and disenfranchised in America. Last year, according to the United Health Foundation, the state of Louisiana budgeted $22 per person for public health, compared to $92 in New York and $83 in Illinois. Nearly 21 percent of Louisiana's population was without health insurance in 2004, and a quarter of the state's children lived in poverty. Louisiana had the nation's second worst infant mortality rate, third worst cancer mortality rate, and it tied with Mississippi for the highest rate of premature deaths in the nation. Right now, in the wake of Katrina and Rita, those numbers are doubtless more dismal.

Federal assistance will soon be flowing to the thousands of Gulf Coast residents who dispersed throughout the country - people the federal government may consider "universal citizens," thus eligible for assistance wherever they have settled, says Surgeon General Richard Carmona. Evacuees will be able to apply for Medicaid without documentation, says Mark McClellan, director of the center for Medicaid and Medicare Services, and a new eligibility category is being developed for Medicaid and State Health Insurance Program recipients. Federal and state officials may take a leaf from New York state, which passed Disaster Relief Medicaid after Sept. 11, 2001, in order to streamline the application and approval process for public-health benefits and extend eligibility beyond one year.

The next crisis, be it an earthquake in California or a nuclear accident along the Hudson River, will likely demand similar bureacracy-busting measures. But why should we wait? Rather than roll out emergency assistance and withdraw it when the emergency has passed, policy makers should recognize that millions of people live in a constant state of crisis. Uncertain of how to get food on the table, they can't begin to contemplate paying for dental work, and they routinely ignore worsening health problems. Even those of us who have insurance and do not need to forgo care pay for the system's flaws daily in the form of higher prices, briefer doctor visits, longer wait times and questionable quality.

Emergency action to facilitate Medicaid applications exposes the dysfunctionality of our health-care system. Crushing bureaucracies, patchwork programs, federal, state and local cost-shifting and unending tweaks and changes to the health-care system have not only pushed health-care costs sky-high - they have also managed to leave more than 45 million people uninsured and millions of others underinsured and with limited access to needed care. We are all of us, from New York to Louisiana to Texas to California, universal citizens, and we deserve universal health care.

As the floodwaters from Katrina and Rita recede, the need to act before the next crisis hits will be laid bare. The dead in the Gulf Coast demonstrate how dramatically the system has failed. But the injured, the chronically ill and the emotionally traumatized who have left the area demand that the health-care system respond. The people who have suffered and are suffering remind us that much of the suffering was unnecessary, for it is always the weak and the vulnerable who suffer most, and the South had a disproportionate share.

The best response would be for policy makers to embark on permanent, not temporary, health reform, and adopt a universal health-care system that fulfills the basic health needs of every man, woman and child in America.

Geoganne Chapin is president and chief executive officer, and Karen Pennar is senior policy analyst of Hudson Health Plan, a not-for-profit Medicaid managed-care plan based in Tarrytown.