Presenting the Framework for a Healthy America

When an injustice burns in your chest and you feel compelled to work passionately for change, the root of that injustice is often personal. Such is the case for me when it comes to fixing America’s growing healthcare crisis.  

My Personal Story

When I was younger, my family and I lived without health insurance for eight years. We were low-income, self-employed, and our options for obtaining insurance were bleak.  

One day my daughter Fionna, then age two, broke her leg sledding and we rushed her to Broadlawns  Medical Center. Though we had always received quality care at Broadlawns, there was no doctor on duty that day who could fix a broken leg. We lived only four blocks from Mercy Hospital but because we lacked insurance, mom and daughter were shipped by ambulance 110 miles to University Hospitals in Iowa City. This resulted in additional costs and loss of work for both parents.  

The care we received at University Hospitals was excellent, but the tab for Fionna’s leg came to over $5,000. Our family’s income was under $15,000 that year, so we approached the local human services office, only to be informed that we weren’t poor enough to quality for Title XIX! Two years and countless phone calls later, a payment plan was worked out and we received some assistance with the bill.  

The Problem

This and other experiences as an uninsured person confirm in me the need for serious healthcare reform. As a lawmaker, I met with hundreds of Iowans who suffered needlessly due to lack of coverage. Their traumas made my own family’s situation look mild, and strengthened my resolve to do everything I can to achieve a comprehensive overhaul of our healthcare system.  

Across America, the reality is the working poor, the middle class, children, and the elderly are falling through the cracks of this system by the millions. There is no reason why the wealthiest nation in the world – a nation that spends more per capita on healthcare than any other – should be the only industrialized democracy without a universal healthcare program for all its citizens.  

Individual states are taking initiative, but America needs reform at the national level. Too many hopes, futures, and lives hang in the balance. Thus far, the federal response to our national healthcare system has been to apply an occasional Band-Aid, when what is needed is a full transfusion. We need a systemic overhaul, and the warning signs are clear.  

• 47 million Americans are uninsured, and at least that many more are underinsured.
• Administrative costs in private insurance run between 20-30%, while administrative costs in Medicaid amount to only 2-3%.
• Prescription drugs are unaffordable for a growing number of Americans, the uninsured, and those with inadequate insurance.
• Both large and small businesses are increasingly unable to offer coverage to their employees or even afford good coverage for themselves.
• Americans spend more than twice as much on healthcare as any other nation, yet we rank 37^th in overall health and well-being.
• According to the 2005 Survey of Iowa Consumers conducted by the Iowa Department of Public Health, 51% of insured Iowans have tried to save on medical expenses by ignoring medical advice, and 44% have had to cut back on food and heating expenses because of medical bills.

 The Solution

The major Democratic candidates for president brought increased attention to the healthcare crisis, and they agreed on the need for extending and improving access for all Americans. While we don’t know the details of the plan the next president will submit to Congress, as your Congressman I will fight hard to help pass a truly universal healthcare system.  

In a just and fair society, quality healthcare is essential for human life and dignity, for a strong economy, and for healthy American families and communities. Quality healthcare must be available to all Americans as a simple matter of justice and human rights. Healthcare should not be a commodity of privilege that is rationed according to an individual’s ability to pay or because of place of employment. Americans need a healthcare system that is accessible, adequate, and affordable for all.  

A change in the way we administer and pay for healthcare is imperative, and the challenge to accomplish this will require leadership, courage, and innovation. I’m not advocating a “one size fits all” government-imposed approach. Americans value choice, and every American should be free to choose a Medicare-style option if they like. Yet individuals and employers would be free to purchase coverage beyond, or outside, the federally funded system. A good analogy is our school system: everyone has access to the public schools. If, for whatever reason, they choose to pay to send their children to private schools, they are free to do so, but they must still pay the taxes that support the public school system.  

We must, however, find a way to cover those who cannot afford health insurance so that they need not fear choosing between their heath and other basic necessities. To ensure coverage for everyone, we need to look at healthcare as a sustainable resource to be managed rather than as a commodity to be bought and sold.  

Accessible Care

I will work to assure good access for all Americans based on need, not income. In my own personal situation with my daughter’s broken leg, we had great care but horrible access, which in the end cost more money and wasted huge amounts of time.  

Americans must have the freedom to choose their physicians and hospitals. Approved medical and healthcare providers should be independent members of the public or private sector. Efforts must be made to find ways to balance cost efficiency with compassionate and effective treatments.  

Adequate Care

Adequate healthcare should be every American’s birthright. The kind of system I will work for would include the following services and priorities:  

• Incentives to help Americans choose healthier lifestyles
• Quality primary care, which is the least expensive and most cost effective initial point of care, and helps build a long-term patient-provider relationship
• Prescription drugs available to all Americans and not rationed only to those who can afford them
• Mental health and substance abuse care as part of the total healthcare program
• Dental and vision coverage
• Alternative medical care services, including acupuncture, chiropractic care, and midwifery
• Hospice and long-term medical assistance for the elderly and those with terminal conditions
• Preventive care

Affordable Care

Healthcare should be affordable for all Americans. I will work for a universal healthcare system that is publicly and privately financed, one that provides Americans the option of continuing to use private insurance but doesn’t require it. By eliminating administrative waste and spending limited healthcare dollars more wisely, Congress can find the money needed to implement a universal healthcare system that will reduce the cost of healthcare for most Americans.  

A Word About Personal Responsibility

While the kind of changes I support create a healthcare system that is truly democratic – based on need, not income – every one of us has a responsibility to reduce the necessity for healthcare services through healthy living. Ultimately, the decision to eat well, exercise, and avoid harmful substances is one that only each individual can make.

However, it is also important to expand and make viable the role of public health departments to educate Americans about both healthy and harmful practices. Along with that, healthcare providers – nurses, physicians, physician assistants, nurse practitioners, physical therapists, chiropractors, mental health therapists, midwives, etc. – also have a vital role to play in prevention and wellness. Still, government cannot abdicate its responsibility to help encourage all of us to make healthy choices.  

The Challenge 

A key obstacle to healthcare reform is the presence of special interest money in politics. When one sees the huge amount of money that insurance companies, drug companies, medical interests and their lobbyists pump into political campaigns, one begins to understand why reform is so elusive.  

The bottom line is, if every other industrialized democracy can provide quality care to all its citizens – and for less money – why can’t we? Indeed, if a majority of politicians had to walk a mile in the shoes of those who lack insurance, who have suffered needlessly because of the current system, we would have a comprehensive, functional healthcare system in no time at all.