Robert Moscato-Goodpaster


Your Health in Their Hands

Originally published in Ball Bearings

Experts discuss the politicization of health care.

The issue of health is something that affects everyone, whether it be experienced personally or through a loved one. People will get sick, but with the advancements in modern-day antibiotics, a lot of maladies can be cured. However, access to these antibiotics can come at a cost—sometimes too high of a cost, even if it is a vital part of helping that person get better. This is where the issue of health care comes into play and the kind of health care that you have is greatly affected by policies made by those in government. Some of these policies can be seen benefiting the greater good and others not so much. 

Many argue that the responsibility of making sure that all Americans are covered falls on the government, but not everyone can agree which leaves policy makers unable to satisfy everyone, causing an endless flaw in the health care system. While there are some policies placed in effect to help ensure a wide-range of coverage to everyone, such as The Healthy Indiana Plan or Medicare, they still fail to please and help everyone. Even after an increase of 5.8 percent in health care spending in 2015 to reach $3.2 trillion dollars, it still seems to fall short to meet the needs of Americans.

In order to gain a deeper understanding on why the issue of health has become more politicized, four professionals offer up their thoughts based on what they have witnessed and noticed in the health care system.                                                

Daniel Reagan received his Ph.D. from Notre Dame University and has worked at Ball State University since 1989. He is the current chairperson of the Ball State UniversitDepartment of Political Science.

I guess as a political scientist who pays attention to health care in the United States, [I would say] it’s long been sort of a controversial public policy issue. And I think there are a couple of reasons for that. One is that it deals with our health, our physical well-being, our life, and the lives of those that we love. So a lot of people have a vested interest in it, in ways that are not so true, for instance, in relationships or labor issues. Another thing is that in America, it’s become sort of a symbol for things that are larger for health care. So, all the way back to 1920s, 30s, 40s, 60s, and early 90s, health care seemed to be seen by some Americans as an important right. There have always been groups that thought that Americans ought to have the right to health care. And so, an act of health care is something the government should have a role to play in. But there have always been Americans with the opposite view. For the government to get involved in health care, it’s taking on a power that maybe the Constitution doesn’t give.

It’s almost always been seen as a symbol of this larger debate in the country about the proper role of government.

Democrats are not quite as united on health care, at least on a congressional level. So, for example, one of the things happening right now in the Democratic Party is Bernie Sanders is proposing what they call a single-payer health care system. Right here in Indiana, for example, our democratic senator Joe Donnelly is up for re-election, and I don’t know for sure that he has taken a position on it. I would bet that he is not going to be for single-payer because in the political culture of Indiana, that is going to hurt you.

Laura McCaffrey is the public affairs specialist for the Indiana Hospital Association, an organization that helps advance a health care delivery system that improves health and health care. McCaffrey received her bachelor of arts in communications from Ball State University. She has also served as a legislative intern for the Indiana State Senate and was responsible for tracking legislation in addition to advising legislators on policy matters.

I would say health care itself is not necessarily a partisan issue, but any issue that occupies 25 percent of the federal budget lends itself to partisan disagreement over how resources are spent. I think our country has become more polarized in recent years for a variety of different reasons and I think health care, like most other economic sectors in America, has fallen subject to that. Congress just made several attempts at health care reform, and in Indiana hospitals we have consistently urged the need for bipartisan legislation to provide meaningful pathways to coverage. In Indiana, there has been support for the Healthy Indiana Plan and its inception was about a decade ago. That demonstrates that states can successfully extend coverage in an innovative and fiscally-responsive manner. In my professional experience, I do get to see lawmakers working together across the aisle in compromising at the state level in health committees in Indiana at the state house. Congress passed important legislation that is bipartisan related to health care, but unfortunately, I think that that doesn’t get as much attention as the ACA [Affordable Care Act] repeal and replace issue.

Nir Menachemi is a professor and health policy and management department chair at IUPUI. Menachemi has published more than 200 peer-reviewed scientific papers, and his work has appeared in numerous prestigious professional journals, including the New England Journal of Medicine and Health Affairs. He also holds an appointment as affiliated scientist with the Regenstrief Institute, an internationally recognized informatics and health care research organization dedicated to the improvement of health through research to enhance the quality and cost-effectiveness of health care.

I don’t think that it is just health. I think health is most obviously politicized right now because I think the stakes have never been higher. We have sort of a growing aging population that continues to consume more and more services—the older generation is increasingly becoming Medicaid-eligible and, as a result, increasing the use of services. At the same time, as people transition into retirement and onto Medicare, thus using more services, they are no longer contributing to Medicare through payroll taxes because they are retiring. Our health care system has not been set up to be financed in the way that it is now being demanded of. And so, we have this important societal issue that needs to be dealt with, and in a climate where everything is politicized, it’s not surprising that health care is also. I think we talk very much ideologically about health care, but we never really talk about what’s the right thing to do, nor do we as a society want to give people the right to health care. We have decided as a nation that everyone has a right to education. When kids grow up they get elementary school, they get middle school, and they get high school, and everyone is okay with providing that. But we have not had similar conversations about health care. Instead, I think we have ideological differences and points of view on how to fix it, and frequently we don’t want to look at the evidence or engage in the right dialogue, which is trying to push one ideology or the other on how to handle the health care system.

Joshua R. Vest is an associate professor, and director for the Center for Health Policy at IUPUI. He received his Ph.D in Health Services Research from Texas A&M University, and M.P.H. in epidemiology from Saint Louis University. As a former local public health practitioner, he has a particular interest in effective public health information systems. This response was received via email.

The health care system is complex. There are no simple solutions. As a result, it is easy for people to default to ideologies and opinions than to explore evidence and deal with tough questions.

Moreover, health has a few characteristics that make it important. First, it is universal. Everyone at some point will be sick or concerned about the health of a loved one. Second, health is a source of uncertainty. When people worry about their health, it creates stress and anxiety. Third, health, and particularly health care, is expensive. We spend more on health (as a percent of GDP) than any other industrialized nation. In fact, our spending has been growing over time and, unfortunately, we have very little to show for it. The U.S. lags behind most nations on a variety of health outcomes. Lastly, health manages to incorporate several other political tensions: independence vs. collective good; personal responsibility vs. regulation; cost vs. benefits; and societal and economic disparities. All of these features make health politically important to the public, various stakeholders, and those making policy.

Ball Bearings has edited statements for clarity.

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