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BLOG: Where do we go from here?
In the waning days of March, we all witnessed a fascinating event in American politics. Many of us clustered around the television to watch the vote on the American Health Care Act of 2017.
To some, this vote could be the defeat of the work of the past 7 years that had provided health care insurance for roughly 15 million Americans. To others, it was the repeal of a law that placed the federal government in the health care business and deprived our citizens the freedom to make their own decisions on their personal health care.
But there was a third group, a moderate and apolitical group, that viewed this as an opportunity to address the American health care crisis with fresh ideas and lessons learned from the Affordable Care Act. This group did not particularly care if we called it RomneyCare, ObamaCare, RyanCare orTrumpCare as long as it moved us forward on the path to health care reform.
But the decision to do nothing, to pull the vote, to just walk away and ignore it seems totally irresponsible. We know that the ACA needs major revisions, and the AHCA could have addressed some of these and taken us to the next level. I am sure it would not have been perfect but it could have provided more data points to fine-tune the next revision.
So, what is the American health care crisis? Why can’t the federal government just ignore the whole question and leave it to the states or each individual to make their own choices about their personal health care?
The role of the federal government is nicely established in the Preamble to the Constitution. One of the key missions is to “promote the general welfare.” To gauge this, we need to look at the “general welfare” of the other civilized nations of our modern world.
If we look at the 191 countries of the World Health Organization (www.who.int/en/), the U.S. ranks 72nd on overall levels of health, and our health system ranks 37th. To get more specific, we need to look at the industrialized countries as represented by the country members of the Organisation for Economic Co-operation and Development (OECD) (www.oecd.org). Of the 34 member countries reporting, the U.S. ranks 29th in infant mortality and 34th, dead last, in life expectancy.
By any measure of world health standards, the U.S. ranks poorly. With our standing as a world “super power” and as one of its richest nations, it is shocking that our federal government continues to stumble and can literally walk away from one of the principle missions of our Constitution by failing to promote the general welfare of our citizens.
If we take a closer look at the health statistics of the countries of the OECD, we may see the reasons for the failure. Americans spend on average $8,233 on health care per person per year (based on 2010). This ranks us as the No. 1 most expensive, and the amount that we spend is 2.5 times more than the OECD member country average. We spend 17.6% of our gross domestic product on health care, again, giving us the number one ranking, and here we are spending double the average.
So, the problem is clear, in spite of having some of the world’s best doctors and hospitals and leading the world in innovative health care services, basic health care services are unaffordable for the average citizen. Sadly, this is not a new problem. This problem was widely publicized in the 1980s. I learned about this in Public Health 101 in optometry school in the 1970s.
The solution, however, is not so simple. There are a few things that we as optometrists can do to move the situation in the right direction.
First, we need to learn about the issues, the proposed solutions and the politics involved. This can be best achieved by active participation in organizations such as the American Optometric Association and the American Public Health Association. Read the literature, opinions and commentary on all sides of health care issues.
Second, vote for the politicians who not only talk a good game, but also vote in a thoughtful and logical way for legislation that will move us toward a solution.
Third, help move our profession to meet the need for primary health care. Here are some steps in that direction:
–Attend continuing education on the management of chronic medical problems such as diabetes and hypertension;
–Add vital signs to your comprehensive eye examination;
–Counsel or refer your patients at risk for systemic medical problems; and
–Work with your state association to expand the scope of optometry to allow a more aggressive management of chronic medical conditions.
We may not be able to solve the health care crisis with our actions alone, but perhaps we can move the needle. We may even be able to set a good example to our lawmakers on how to promote the welfare of our fellow citizens.