Talking About Health; Why Health Communication Matters

Public Health and Health Insurance as a Public Good: Part 3

October 30, 2013

While the media has given a lot of coverage to citizens complaining about having to pay for health insurance for pregnancy when they are men or have wives past child-bearing age/interest, or for pediatric care, or birth control–the story being lost is the one about health insurance as a public good. If all citizens have access to a certain level of care, then all citizens should achieve a certain level of health, and that should be good for all of us, the public good associated with health insurance and the public’s health.

Of course, we hear these arguments in other contexts. There are people who don’t have children who don’t want to pay for public schools. People who don’t use the interstate system not wanting to pay for maintenance of the interstate system. So it seems to be a very old tune, but the words for the new verse haven’t been rehearsed very well. Without telling more about how sharing the cost of paying for a level of health care aims to benefit all of us, complaints get heard and the argument for the ACA gets lost.

Likely, over time, debates will unfold as data collects to support or fail to support ACA’s benefits for society. Will we improve on some of the major health indicators, such as infant mortality rate–with the U.S. ranking 30th on a recent list [http://www.cbsnews.com/news/us-has-highest-first-day-infant-mortality-out-of-industrialized-world-group-reports/]. That is the hope. It will likely take some discussion and some effort to work toward achieving such aims. And some revision of the ACA. A foundation of understanding related to its purpose is a good place to start.

Social Justice, Workers, and the Affordable Care Act: Part 3

September 25, 2013

In the first two decades of the 20th century, middle class progressives realized that the American industrial society’s working-class citizens suffered ill health and injury through no fault of their own. Work places were often unsafe, causing injury to workers and their ability to work. In recognition of these facts, a number of economists formed the American Association for Labor Legislation (AALL) in 1905 for the purpose of studying labor conditions and labor legislation [see http://www.proquest.com/en-US/catalogs/collections/detail/American-Association-for-Labor-Legislation-38.shtml].

The AALL group advocated for health reforms in industry and sought compulsory health insurance. Initial efforts to argue the merits of such legislation focused on workmen’s compensation. This strategy aimed to provide access to care for workers injured on the job.

Woodrow Wilson joined the AALL [http://www.ssa.gov/history/corningchap1.html]. He included their social insurance plank in the 1912 Progressive party’s platform. In 1915, the AALL published a model health insurance bill in legislative language to be considered by State legislatures, with California, Massachusetts, and New Jersey supporting the proposal out of the 12 States that discussed it. As debate continued within the States, so did opposition to a proposal for government health insurance. AALL leaders assumed that such reform would be viewed as beneficial to all. The stage was set for health insurance to dominate conversations about health care.

Social Justice, Military, and Affordable Care Act: Part 2

September 20, 2013

Other early federal debates led to the provision of health care to the armed forces, naming the public good and satisfaction of economic aims to support the government’s role. It was argued that a healthy army and navy were necessary for national defense. The patchwork of care for the U.S. military covers decisions relating to those who serve, have served, and their families [see http://usmilitary.about.com/cs/healthcare/a/medicalcare_4.htm for a summary]. Lost in the conversation about the uninsured and the Affordable Care Act is the data about our nation’s veterans. They comprise a very large group of the uninsured. Here is the estimate from the Robert Wood Johnson Foundation: http://www.rwjf.org/en/research-publications/find-rwjf-research/2013/03/uninsured-veterans-and-family-members.html — 1.3 million veterans plus their families [about another 1 million] have no access to health care.

How does the Affordable Care Act affect military families? An analysis that includes comparisons between Tricare and ACA requirements appears at: http://www.militarytimes.com/article/20130926/BENEFITS06/309260025/Affordable-Care-Act-No-impact-Tricare-some-coverage-isn-t-equal. It appears that the ACA will require more coverage than Tricare offers in various instances.

As for veterans and their families, if their income levels fall within Medicaid guidelines, they may receive care through an ACA Medicaid-expansion option. That depends upon their State’s buy-in, however, so it remains unclear whether this group of hundreds of thousands will find a path to care or not.

Social Justice and the U.S. Affordable Care Act: Part 1

September 15, 2013

As President Obama took on the health care issue, his overall aim appeared to be to address access to health care for those who do not have it. This includes some of our most vulnerable citizens, ranging from children living in poverty to the elderly who lack the resources for care. This President, as others before him, sought to promote the dignity of citizens through the provision of health care and to exercise social justice in ways that represent ideals expressed in the Declaration of Independence—promoting “life, liberty, and the pursuit of happiness.”

The U.S. Constitution, which was adopted in 1787 as the supreme law of the newly formed national government for the thirteen states, does not endow Americans with a protected right to health care. This was a conclusion reached by the U.S. Supreme Court but one that finds itself at odds with other republics where a level of health and health care are explicitly guaranteed [see Poland, for example—p. 3 of http://www.ehma.org/files/Benefit_Report_Poland.pdf].

The reasons for an absence of reference to health and health care in the U.S. Constitution likely reflect both the desire to avoid government intervention—related to the very foundation leading to the formation of this nation–and the practical reality that medicine was in its infancy at that time. Thus, there was not much anyone, let alone government, could do to promote the health of individuals. Family comprised the primary unit of both social and economic life, and family assumed the role of caring for sick and injured members.

Very early on, these realities conflicted with the fact that merchant seamen, who acted on behalf of the welfare of all U.S. citizens, became ill and/or disabled in the performance of their duties. Thus, it was only “just” to pay for their health care. In accord with this premise, Congress passed an act to provide for merchant seamen’s medical care in 1798. Congress used the authority of Article I, Section 8 of the U.S. Constitution to support this policy. It empowers the federal government to regulate commerce with foreign nations and to tax for the general welfare as a means to that end. The health and well-being of individual seamen was not the argument used to support a role for government in providing health care. The need for a government role in health and health care resided in a focus on promoting commerce. Government efforts to provide health care, however, were squarely on the table, beginning a path toward where we are today.

CESAR–Center for Substance Abuse Research: High school students’ use of nonprescribed prescription drugs

June 24, 3013

You can sign up to receive a weekly fact sheet called CESAR FAX in your email. Go to http://www.cesar.umd.edu/cesar/cesarfax.asp. The May 6th, 2013 issue asked 3,884 U.S. high school students why they use prescription drugs without a prescription. The number one reason given by 18% was ‘to help me relax’ followed by’16% who reported ‘to have fun’. If you add in the 13% who said ‘to help me forget my troubles’ and the 11% who said ‘to deal with pressures and stress of school’–you have 42% using prescription drugs that were NOT prescribed to them to deal with anxiety and stress. We truly need to find creative programs to help high school students deal with their daily lives–programs that do not include prescription drugs that were not prescribed for the students using them.

Talking about Angelina Jolie’s dislcosure about BRCA mutation and surgery

June 4, 2013

With Angelina Jolie’s disclosure about testing positive for the BRCA mutation that strongly predicts the likelihood of developing breast cancer, a lot of media stories have covered her genetic testing diagnosis and subsequent decision to have a mastectomy. A number of important ideas have been included in Angelina’s talk about her diagnosis and decision. She has emphasized that the genetic test is expensive–about $3,000. Perhaps there has been less emphasis on why and when health insurance is more or less likely to pay for the genetic testing, or some part of it at least. Payment is more likely in situations where a family member has tested positive for the mutation or has developed breast cancer at a young age.

The story has focused more on her decision perhaps than on the relative rarity of having the genetic mutation linked to breast and ovarian cancer. The decision to have the mastectomy relates to the 85% or more likelihood that she or anyone with the mutation would develop breast cancer. So this mutation of a gene that we all have is indeed very strongly indicative of a future breast cancer diagnosis. The decision to have breast tissue removed is Angelina’s way of reducing that risk to more like 5%.

Another fact that the stories have not emphasized is the reality that only about 5% of the women diagnosed with breast cancer have a BRCA mutation. For the other 95%, environmental and behavioral factors contribute to the diagnosis. So it is critical that we focus attention on that reality.

The federal sequester and health communication

February 28, 2013

Little else dominates the news right now besides the sequester. I have to wonder if anyone has calculated the costs associated with calcuating the costs of cuts linked to the sequester. Here is just one example: http://astho.org/Advocacy/Sequestration-Fact-Page/ The Association of State and Territorial Health Officials has taken the time from their already overloaded and underfunded docket to explain the effects of the impending cuts as envisioned. The picture is not pretty.

Besides the lost dollars and lost work hours, the lost productivity across all kinds of spheres associated with this ‘event’ relates to emotional tolls and the anxiety within families created by such uncertainty. These events turn into physical and mental health problems, including diseases associated with stress and depression. Interpersonal violence increases in personal and social relationships.

I hardly know what to say. From an ethical perspective, the dilemma linked to distorting and manipulating information for so long leaves so many with feelings of distrust. I like a good debate probably even more so than the average citizen, but the time is long past for beating the drums of authority and power, and instead to lead by example.

How do we communicate about responsibility and health?

July 18, 2011

I have been basking in the summer heat… catching up on some research and and reflection, and most importantly–my family. July is the month that my granddaughter, Grace, visits… and we have been reading the American Girl book that introduces Kaya…an American Indian. And that is what made me think of today’s topic.

Chapter 2 of the book introducing Kaya, the title is ‘Switchings’, Kaya and all of the youngsters old enough to share in the responsibility for Kaya’s mistake [leaving her twin brothers when she was responsible for watching them] gets a ‘switching’ — that is, she must lay face down on the ground along with all of her peers and pull her clothing up on her legs to her knees. Then the ‘Whipwoman’–elected by the tribe to administer switchings to the youth–takes twigs from a tree and gives the children lashes. The message is that what one of them does affects all of them… So, the bad behavior of one gets all of them into trouble….

Grace is 7 years old… I asked her what she thought about everyone getting a switching because Kaya had done something wrong. She said that it was fair because Kaya went off with two boys to ride horses when she should’ve been watching her brothers. So, she said, those boys should be punished, too. What about the others, I asked What about some of the kids who were punished who were nowhere near the other three kids? It seems fair…what we do does affect everyone, and everyone should support us in doing the right thing…

Interesting. I considered that I might use this book in my health communication classes this year to capture the many meanings of responsibility and health. Personal responsibility, as illustrated here, has more meaning than just what and how our behaviors affect our own health… It affects others, including the nation’s health care costs. But it is impossible to be responsible when all around us are people and ways temptinig us to forget about what we know we should do. And when there seems to be no support on the other end–no one and no ways to achieve the right things… ‘Switchings’…it is a good metaphor for what we are doing to ourselves as a nation when it comes to health and health care…

What do you think about tobacco settlement dollars?

March1, 2011

It is a fascinating history filling volumes of research journals and books and ledgers… The tobacco settlement… It came to my attention again today as I was reading about Pennsylvania’s adult basic health insurance program.

Mostly, in the past several days, I’ve heard sound bites about the program shutting down and leaving Pennsylvanians uninsured. The shutdown in the stories I’ve heard seemed to be linked to state budgets and all that is going on there. Today, I had a moment to explore more about these soundbites and learned that…the program began under Governor Tom Ridge who used the State’s tobacco settlement funds [http://onevoicetulsa.com/index.php?ht=display/ContentDetails/i/4424680].

The tobacco settlement was designed to provide states with funds to address increased health care costs related to tobacco use…smoking. This was to include cessation programs as well [http://www.tobaccofreekids.org/what_we_do/state_local/tobacco_settlement/].

One might ask how we get from the the latter to the former? We all share higher health care costs linked to smoking…whether or not we smoke or have smoked. So perhaps it was a creative and even equitable program that the former governor introduced…

How do we talk about a right to health care in the U.S.?

October 14, 2010

It was little more than a decade after the Constitution was adopted when the U.S. Congress debated a role for the government in providing health care for some U.S. citizens. It was argued that when merchant seamen, who acted on behalf of the welfare of all U.S. citizens, became ill and/or disabled, it was only “just” to pay for their health care. In accord with this premise, Congress passed an act to provide for merchant seamen’s medical care in 1798. Congress used the authority of Article I, Section 8 of the U.S. Constitution to support this policy. It empowers the federal government to regulate commerce with foreign nations and to tax for the general welfare as a means to that end.

So–the health and well-being of individual seamen was not the argument used to support a role for government. The need for a government role in health and health care resided in a focus on commerce. If the seamen could not do their jobs, it could harm the nation’s commerce. Other early federal debates led to the provision of health care to the armed forces. It was argued that a healthy army and navy were necessary for national defense. Then, in the first two decades of the 20th century, middle class progressives realized that the American industrial society’s working-class citizens suffered ill health and injury, affecting their ability to work–harming the nation’s productivity levels.

Workplaces were often unsafe, causing injury to workers and their ability to work. In recognition of these facts, a number of economists formed the American Association for Labor Legislation (AALL) in 1905 for the purpose of studying labor conditions and labor legislation. The group advocated for health reforms in industry and sought compulsory health insurance. Initial efforts to argue the merits of such legislation focused on workmen’s compensation. This strategy aimed to provide access to care for workers injured on the job. Woodrow Wilson joined the AALL. He included their social insurance plank in the 1912 Progressive party’s platform. In 1915, they published a model health insurance bill in legislative language to be considered by State legislatures, with California, Massachusetts, and New Jersey supporting the proposal out of the 12 States that discussed it.

As debate continued within the States, so did opposition to a proposal for government health insurance. World War I produced the War Risk Insurance Act that established a comprehensive system of benefits for servicemen and their dependents. A broader policy was defeated, however, with AALL leaders naively assuming that such reform would be viewed as beneficial to all.

Once access to health care is argued around the role of commerce, the challenge becomes how to separate whose ill health and injury would not fit within that realm. If each citizen who works–and this includes those who work inside the home to enable others to work outside the home–contributes to the economy, then the argument appears to support the need to guarantee health care for all. Children will be the next generation of ‘workers’, so their care should be supported as well.

The Congressional Committee on Costs of Medical Care in 1927 proposed Health Maintenance Organizations [HMOs] as a strategy aimed to provide affordable health care to all citizens. A minority report written by doctors and adopted by the American Medical Association took the position that HMOs would hurt the quality of health care. As a result, the Committee’s recommendation was not seriously considered. Congress, however, initiated a program to cover its own members’ health care. And so, talk about a right to health care in the U.S. a century ago…not very much different from talk about a right to health care in the U.S. today.