Federal Action Required on Healthcare

Government-mandated universal healthcare will keep the nation healthy, writes scholar Judy Feder.

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Judy Feder, a fellow at the Center for American Progress, is a former dean of Georgetown University's Public Policy Institute.

We didn't need an election to tell us our healthcare system is broken. From declining coverage to increasing costs to escalating levels of chronic disease, our healthcare system isn't promoting our nation's health the way it should. American families bear the pain. More than 45 million Americans lack health insurance and are therefore less likely to receive timely, adequate, or high-quality healthcare. The Urban Institute has estimated that 22,000 people die each year because they lack coverage. The uninsured live sicker and die younger than people with coverage.

Even when they have insurance, families find their well-being threatened by health insurance costs, which are rising almost four times as fast as worker earnings. At the same time, employers are shifting a greater proportion of those expenses to families through high deductibles and other costs. In 2007, 57 million Americans had problems paying medical bills. At the most extreme, health expenses are a factor in half of all personal bankruptcies, with nearly half of people in foreclosure naming such costs as a cause. Others have turned to credit card debt to cover their healthcare costs. And as the nation has learned, the collapse of our financial markets has been intimately tied to consumers carrying debts--including healthcare costs--they cannot manage. Health insecurity is part and parcel of our nation's economic insecurity.

To rebuild our economy, we must rebuild our healthcare system--not only to ensure healthy futures and economic security for American families but also to develop and maintain healthy, productive workers and alleviate health costs' crushing burden on small and large employers.

Concern about the economy topped voters' list in the election, and healthcare--an economic issue--was not far behind. The election didn't tell us we had a healthcare problem, but it did tell us that voters expect a solution. And it doesn't lie in simply making Americans "better shoppers"--arming us with information and technology and leaving us to navigate the marketplace on our own. Without public action to change the rules and assure affordable insurance, healthcare providers will never focus as much on preventing illness as on treating it, costs will continue to rise, insurers will always cover people who are healthy and avoid insuring people who are sick, and we will always be at risk of falling out of the healthcare system when we need it most.

An effective solution requires government action. We need government to create the structure and incentives to refocus our healthcare system on promoting health--by investing in the prevention and management of chronic illness, adoption of information technology to assure quality care, and treatments that the evidence shows actually work. These actions are a win-win--first in making us healthier, second in making healthcare affordable.

Safety net. We will achieve these wins only if everyone has health insurance that promotes health. Effective insurance means not only covering everyone but also supporting prevention, disease management, and the full range of services doctors prescribe. It means assuring that everyone can get those benefits from insurance plans that can no longer deny coverage or charge more based on pre-existing conditions. And it means assuring that benefits are affordable to people of all incomes, with help for premiums and a strong and secure safety net for the most vulnerable.

Refocusing our healthcare system and achieving universal coverage require government action--not a government takeover or "socialized medicine," as some will label any government-led reform. Here, the election offers us an opportunity. This is hardly the first time that health reform has been on the political agenda. But it may be the first time that critics will be unable to scare Americans into believing we have more to lose than to gain from healthcare reform. Today, it's not change in our healthcare system we should fear; it's more of the same. Our newly elected leaders owe us a healthcare system that works.

Corrected on 01/30: An earlier version of this article left out a short bio of Judy Feder. That information has been added.