Health Focus: The Role of Government in Health Care

The bitter debate going on in Washington is really nothing new for health care since the opposing parties have very different views on how care should be delivered in the United States. We are unique in the world since we have an employer-based system that dates back to World War II when wages were frozen but employee benefits were not, so today if you have a job there is a good chance that you have some health insurance. Somewhere around 160 million of us get our health insurance from employer-based or individual private insurers.

Government, public insurance, is another important source of coverage with Medicare and Medicaid providing benefits to some 100 million children, elderly and poor. This leaves about 50 million without private or public provided health insurance, namely the uninsured.

When you consider that we spend more than any other country in the world in absolute dollars and per capita but fail to insure 50 million, you naturally ask the question- Why is this so?
The simple answer is that health care in America is very expensive and grows at a far faster rate than almost every other product or service we buy. This fact underlies the escalating costs of health insurance premiums and makes it increasingly unaffordable for many low wage individuals, small firms, and of course the poor who are not poor enough to qualify for a public program like Medicaid.

The debate of how to address this problem is between social conservatives who argue that the employer-based system is best versus social liberals who support a stronger role for government. Conservatives blanche at more government and point to the shaky solvency of Medicare and the financial stress that Medicaid places on states and local governments. Liberals portray the current system as lacking basic fairness as the uninsured are forced to seek care in hospital emergency departments or denied needed care altogether. Conservatives seek ‘market solutions’ whereas liberals rely of government support.

What is the role of government? We could probably get wide agreement that we need public support for the disabled, aged and the poor. However defining who is poor is where a line must be drawn. The new reform law crafted primarily by social liberals provides support by extending Medicaid income eligibility and providing subsidies to lower wage earners in the coming exchanges. Conservatives blast these provisions as overreaching and financially irresponsible.

All this wrangling is about how to make health insurance affordable but little is being said about how to address the underlying problem-- the excessive cost of health care in America. Isn’t it time that we stopped relying on politicians for solutions and instead took some personal responsibility? Why don’t we individually declare a war on obesity? Think of this. Nearly one-third of children ages 10–17 and U.S. adults were overweight or obese in 2007. And with the strong association between obesity and many chronic diseases, including type 2 diabetes, cardiovascular disease, several types of cancer, musculoskeletal disorders, sleep apnea, and gallbladder disease- isn’t it smart to shed some pounds? A slimmer nation will be healthier and less costly to care for. Let’s make it happen- THIN IS IN!

John Sardelis is an Associate Professor of Health Administration at 's Long Island campus in Patchogue.

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