Health Care Reform – One Step in Long Stairway

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The recently passed health care reform bill ultimately will do a lot to support the health of the people of Ohio. It expands Medicaid coverage to the near-poor and to childless adults who couldn’t get coverage before. It prevents private insurers from denying coverage to people with preexisting conditions. Ultimately, it will cost us less, not more.

But with all the hoopla, tea-partying, and hand wringing over health care, let’s not forget: health care is just a means to an end – great health. And even good health care coverage is only one step on that stairway.

Consider that, according to the Congressional Budget Office, by the year 2019, when all of the law’s key provisions will have been phased in for a while, 23 million people still won’t have insurance. Many of them will be people who earn too much to qualify for Medicaid but too little to afford even a relatively cheap subsidized plan. The new health care law is a big step in the right direction, but it’s not truly universal health care.

We also know that broader coverage by itself won’t increase the number or capacity of health care providers in under-served communities. A lot of Ohio counties have been designated by Health and Human services as “medically under-served areas” or “health professional shortage areas. Even without further explanation, you know that’s not good. Having insurance doesn’t necessarily mean you get to see a doctor.

And then there’s the sticky business of how providers treat the patients they see. In one recent American Medical Association survey, 55 percent of doctors agreed that “minority patients generally receive lower quality care than white patients.” Two in three acknowledged having seen a patient receive poor care because or his or her race or ethnicity. The new health care law does little to address those issues.

Finally, we have to appreciate that there’s a lot more to health than health care. Public health experts will tell you that health care quality and access explains 10 maybe 20 percent of health care outcomes. Much more is due to what they call the social determinants of health – things like food quality, poverty, working conditions, housing, stress, and neighborhood environment.

The health care law won’t do much about those things – and that’s assuming it survives public ambivalence, the lawsuits planned by Attorneys General in more than a dozen states, and the practical challenge of actually making it work on the ground.

The point is that even if all these challenges are met, we have even more critical work ahead of us. Until we muster the national will to engage the entire range of conditions that compromise our health as a people, and the health of poor people, folks in rural areas, and people of color in particular, health care reform can only be a very partial solution.

Andrew Grant Thomas is a WOSU Commentator and deputy director of OSU’s Kirwin Institute for the study of race and ethnicity.

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