How health care reform can improve public health

by Paula Hartman Cohen

Have we overlooked the public health aspect of health care reform?

In the health care reform debate, we’ve heard and read how health care reform will or will not work, what it will or will not cost, and how it will or will not impact each one of us as individuals.

We’ve also heard from those who have great faith in our current system, and sincerely believe we should leave it alone.

It may work well for some people, but, on the whole, our nation does not hold up well in international comparisons. In fact, we come in 37th on the World Health Report 2000 and, according to a London School of Hygiene and Tropical Medicine report, the U.S. has the highest rate of preventable deaths among 19 industrialized nations. Clearly, there’s room for improvement.

My question is, will health care reform improve public health, or not?

For answers, I turned to Howard K. Koh, M.D., assistant secretary of health for the U.S. Department of Health and Human Services (HHS). Koh is senior health adviser to the Secretary of HHS, and he oversees the Office of Public Health and Science, the Commissioned Corps of the U.S. Public Health Service, and the Office of the Surgeon General. Previously, he served as associate dean and director of the Division of Public Health Practice and the Center for Public Health Preparedness at Harvard School of Public Health. From 1997-2003, he was commissioner of public health for Massachusetts.

In a recent interview, Koh told me we can “absolutely” expect to overall public health to improve if we provide quality, affordable health care coverage for all Americans.

“Health insurance reform will link people to health care services and assure access to quality health care,” he said. “Reform will also protect people against unfair insurance practices so they won’t be denied coverage as a result of a job loss or a pre-existing condition.”

Right now, millions of Americans cannot get coverage and 14,000 more lose their insurance every day, Koh said. “When Americans go without health insurance, they suffer.”

That suffering isn’t limited to the uninsured. Many with insurance fear they will lose their benefits. According to Koh, one in six Americans who had employer-sponsored insurance coverage in 2006 lost that coverage by 2008. As a result, many children and adults went without preventive care, immunizations, basic dental services and prescription medicine. “When sick, [the uninsured] are more likely to experience poorer health outcomes” than the insured.

“We are the only advanced democracy that allows this hardship on millions of its people,” according to Koh.

So exactly how will health care reform impact public health in the US? Koh explained:

1. Reform will promote prevention.

“We’re developing a wellness care system that protects health, promotes healthy behaviors and strengthens community prevention…

“A national report recently found that 100,000 lives could be saved each year by investing in five basic preventive services that are available through a doctor’s office…[including] flu shots [for] adults and daily aspirin use counseling for men over 40 and women over 50.“

2. Reform will lead to better quality and continuity of care, in part through the expansion of health information technology.

“Expanding the use of electronic health records is fundamental to reforming health care and reducing preventable medical errors.”

3. Reform will help address chronic diseases.

“Right now, seven out of every 10 Americans who die each year die of a chronic disease. That’s 1.7 million people. And without health insurance reform and an emphasis on regular primary care and prevention, that number is only going to get bigger.”

4. Reform will end denial of coverage based on a person’s medical history, a practice that disproportionately hurts minority populations.

“Many minorities are discriminated against by health insurance companies when they try to get insurance, and we can’t continue to allow this.”

“We can’t eliminate all disease,” Koh said, “but …we can reduce chronic disease by ensuring Americans have the care they need to prevent and treat these diseases so that if they do get sick and need care, they have the best possible chance of getting better.”

In our current system, low-income Americans, including racial and ethnic minorities, are less likely to receive preventive care than others.

“The data are undisputed,” he said. “Minority groups have higher rates of disease, fewer treatment options, and reduced access to health care….this contributes to widening health disparities in our country.”

When it comes to closing the gap on health disparities, Koh said, “we should remember that this isn’t a partisan issue. It’s a moral issue.”

Paula Hartman Cohen is a freelance writer and blogs at birdsonawire.

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