HCR -- Health Care and Being Poor

By John Ballard

Two nuggets I came across today that will be lost unless I grab them...

?Maggie Mahar in a comment thread, replying to another commenter.

I, too, would like to see primary care and prevention dominate our health care system.
But that will never happen as long as so many Americans are poor.

As I have written in the past, there is a limited amount that primary care doctors can do for the poor.

Preventive care doesn't solve the problems of stress, depression, anger, and the self-medication that follows. Sub-standard housing, poor nutrition, no place to exercise and sub-standard public schools all go hand in hand with poverty.

The biggest healthcare problem in the U.S., is chronic disease. A huge percentage of those suffering from chronic diseases are poor.

If primary care docs become political activists, they could help fight poverty in their communities. But ultimately, all of us would have to be involved-- agreeing to pay the higher taxes needed to create the better schools, housing,nutrition and social safety nets found in other developed countries.

As you know, in the U.S. more children are living in poverty than in any other developed country in the world. Even if they get their shots when needed, and see a good primary care doc, they will die six years earlier than wealthier kids.

And many of them will be physically ill and/or mentally ill (depressed etc.) for most of their adult lives. Even if they somehow break out of poverty, get an education, and do everything "right:": eat right, don't' gain weight, exercise, etc., the scars of childhood poverty will cause them to die sooner. They're also more likely to have miscarriages

When we let children grow up poor, we condemn them to tough lives.

Finally, I agree that, in theory, the most important thing that primary care docs can do is to be teacher/coaches and teach patients how to help manage their own chronic diseases and keep themselves healthy.

I say "in theory" because this is likely to work only with relatively well-educated upper-middle class patients (families living on joint income above the median of roughly $63,000)

But the half of all Americans who are not in that bracket are, by and large, not terribly well-educated . (This is in large part thanks to the fact that our public schools have traditionally been financed by property taxes. If you grow up in a wealthier neighborhood, your public school will have more resources. )

Meanwhile, for the past 20 years, middle-class incomes have remained relatively flat. Those in the middle class struggle with economic problems. Increasingly, they cannot afford to send their kids to college, buy a home--or keep up with the mortgage payments if they do. . Unemployment hovers, as a real threat. Healthcare is becoming more and more unaffordable.

Like the poor, those living at median income or below are stressed. They're depressed.

They're not good candidates to learn how to manage their chronic diseases. If eating is my one consolation in life, why should I cut back on the comfort food --or the beer?

Meanwhile the poor have even less education , are even more depressed,and are living the chaotic lives that come with poverty. The chances that they will able to learn how to control their chronic disease are slim to none.

?This morning's Washington Journal, open phones segment...

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Medicaid beneficiaries by definition must pass a means test. It is the safety net for those at the very bottom of the economic ladder.

The caller makes an excellent point about "those who can afford to pay more."
I don't have a problem with a means test for both Social Security and Medicare as well.