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Health Focus: The Role of Government in Health Care

Drawing the line but missing the point.

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.

Patchogue Patch encourages our readers, writers, political officials and anyone in the Patchogue-Medford area to submit their personal views on current events and issues as articles for our Opinion section. Articles submitted should not exceed 500 words, and all submissions will be considered. Please note that these pieces are not necessarily representative of the opinions of Patchogue Patch and represent that of the author. Submissions should be sent via email to michael@patch.com

Paul Wasser February 20, 2011 at 11:59 PM
The U.S. has a habit of thinking bigger is better. This includes the burgers we eat, the cars we drive, the houses we live in, and yes, the entitlements we offer. When are our leaders going to say enough is enough? Yes, we as a country have allowed our eating habits hurt us but on the other hand, to allow 20,000,000 undocumented people to walk in to our ER's and get primary healthcare on the backs of U.S. citizens and work up our medicaid debt to 37.5 billion dollars from our liberal policies and entitlements and then have the audasity to first ask why? And then have the honest working tax payers pick up the tab is outright ludicrious. This may not make me popular but it does make me honest. I would not be a person with much integrity if I took the politically correct way out. That's what got us here!
Heather Reynolds February 21, 2011 at 01:55 AM
American culture coupled with ineffective government will unfortunately bring us no closer to a solution for health care. What will it take to change? If weight and activity are the underlying cause then why not attack the problem through the favorite past-time of Americans of all ages. The food network! Instead of going on the "Diners, Drive-Ins, and Dives" tour why not get physicians, fast food managers, politicians, and all the other stakeholders in our health care dilemma to revamp the way we eat and take care of ourselves. Sure it sounds crazy but isn't that the word we are using to describe the mess we are in. I think we need to start thinking way out of the box and getting our young people involved with the solution. It's their future and we haven't done much to help them out! Shame on us!
Edward Raven February 21, 2011 at 03:00 PM
It is no secret that obesity is a major cause of chronic disease such as type 2 diabetes, heart disease, certain cancers, etc. The government has not been able to control the costs of health care, so we, as a nation need to be held accountable and do something about this ourselves. The public needs to be educated about obesity and its related diseases. We need to be able to control obesity in our children and this will eventually drive down the costs of healthcare. Prevention is the place to start. Instead of spending money on healthcare after the fact, when we need it to control disease, why not spend it up front and prevent disease in the first place?
Patricia Butera February 21, 2011 at 03:58 PM
Asking the government to help in health care reform has been an effort to tax and spend. the government has not been able to understand the real problems in health care. Personal accountability, eligibility for health care based on a healthy lifestyles, credibility in care (only obtaining testing, labs, surgeries really medically necessary) are all factors in health care reform. You cannot open access without putting validity to the test. Many who do not want coverage will have to buy and many who want coverage but do not participate in healthy lifestyles should not be eligible. Why limit the medical history to obesity? Why not include all abuses such as drug and alcohol abuse? We, as a country need to control ourselves and our children to obtain access and quality in health care at a fair price. As a country we need to wake up and smell the fresh air. Individual accountability should be the first step to our walk of life.
Bob Trinchetto February 21, 2011 at 04:34 PM
Yes, a better attitude towards our own personal health is important but I feel that the issue is multi faceted. In the past, a Doctor would assess a condition and offer a prescription. Today, because of their concerns regarding liability, they will put you through a battery of tests just to cover themselves. Attorneys are on the airwaves more than ever asking people to promote healthcare related law suits. Needless tests to keep the attornies away! Also, back in the 80's, you would go to a doctor and pay the bill at that moment. You would then send the bill to your health care provider and be reimbursed an amount. That procedure would make you think twice before you called for an appointment. Today, with low co pays, many people sneeze and make an appointment. We overburden the system. These are just two aspects of a system that is out of control.
Dain Alaia February 21, 2011 at 04:36 PM
I totally agree that individuals must take the iniative against obesity. It is each person's own responsibility to care for themselves and their family's health. But I also think that the government needs to get involved to an extent. The major problem I see with the fight against obesity, is that low income families, cannot even afford to eat healthy if they wanted to. Nowadays, people work as much as they can, to earn as much as they can. A family with 2 working parents does not always have time to make a healthy well thought out dinner. A lot of times they resort to something quick and easy, such as fast food. But when you go to the fast food restaurant, the cost of a salad is 3-4 times that of a double cheeseburger. What if that was reversed? I think the consumer would then make the healthy option. But right now, people can't afford to make that option. If a $5 dinner is all that you can afford, and the healthy dinner is $10...then there's no option but to choose what you can afford. Create a level playing field in the costs of eating healthy, and I think there's an opportunity for progress towards a healthier country...
Carol Reitz-Butler February 21, 2011 at 05:07 PM
Reading these comments, I see a common thread of blame being placed on patients. My co-pay is $40, on top of paying 12K per annum in ins premiums for my husband and myself, not exactly cheap. The high cost of health care in the US is not an issue of patient misuse, but rather the paperwork costs I mentioned combined w/ mismanagement in hospitals and extraordinary amounts paid for end-of-life care. Atul Gatawande has written several insightful articles about this problem: http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande And another: http://www.newyorker.com/online/blogs/newsdesk/2010/12/the-cost-conundrum.html
Noreen Campanella February 21, 2011 at 05:18 PM
There needs to be some governmental role in the delivery of healthcare, however, how can we depend on them for the change that’s needed here in America? We currently see the lack of stability in both the Medicare and Medicaid programs, so how can we expect further help? I agree that one of the underlying problems is the excessive cost of health care and more measures need to be taken to control these costs, especially for chronic diseases and the correlation between obesity and heart disease.
Newbie February 21, 2011 at 07:59 PM
WAR AGAINST OBESITY! Yeah! Let's kill all the fat people! Oops, that won't work...who's going to consume all the cookies, cakes, cereal, Doritos, candy, lunch "meat", milk and beef loaded with growth hormones, genetically modified corn, soda, potato chips, microwave dinners, pizza, e-coli drenched salad greens, Mcdonalds, Burger King, Wendy's, Popeye's, etc, etc, etc? From whom will the doctors/pushers get their salaries and kickbacks when they have no more patients/junkies to dispense the pharmaceutical carginogens? You know - the ones that are advertised ad nauseum on every television commercial break, billboard, magazine and newspaper in this country? Getting the United States hooked on food that makes them sick with indigestion, irritable bowel syndrome, colitis, ulcers, heart disease, high cholesterol, high triglycerides, depression, anemia, cancer, etc, etc, etc is an extremely lucrative business. Kinda like big tobacco. Health insurance is the biggest racket going and until the politicians and pharmaceutical companies and doctors who poison us all admit it the pigs in congress will continue to chase their FAT tails to make it look like they give a shit while their lobbyists make sure that no one in this country ever figures out what the real problem is: THE USDA FOOD PYRAMID.
Bill Powell February 21, 2011 at 09:56 PM
Mr. Sardalis has only scratched the surface. While fighting obesity is a good place to start, we need insurance companies to pay for both well care and control items in addition to keeping prices under control. For example, I know 2 young ladies (one 33years old and one 26 years old) both have type 1 diabetes. The 33 year old has had this disease since she was 22 months old, her insurance covered an insulin pump and she is doing well controling her diabetes. The 26 year old has had diabetes for only 2 years but her insurance company does not cover the insulin pump...she is having problems controling her diabetes and will have complications that will cost a lot more money than an insulin pump to control. The kicker here is both young ladies are covered through Local 338 RWDSU a huge opponent of Wal Mart and a big supporter of Obama care...this union is taking the money of the part time workers and not giving them the basic medical care that they pay union dues for. Greed of the insurance companies, labor unions, large corporations and finally medical providers have driven the cost of health care through the roof. CORRECT...going after the cost of medical care and insurance is a must...competition drives down prices, why not here? Because the insurance companies set the price not the providers...the system needs to be controled but not taken over by the government.
Althea Williams February 21, 2011 at 11:09 PM
Your referred to obesity - what are the statistics on children between 10 -17 years of age whose parents (or selves) go to the doctor for routine checkups (not pregnancy, STDs, etc.) who have no co-morbidities and compare to those stats with those children who have chronic illnesses. This population is not focused on the importance of healthcare and I'm not convinced their parents, particularly if there no co-morbidities. Insurance companies, government, physicians, hospital, education and food industries are all regulated but they still can’t find a way to reduce the cost of healthcare, achieve healthier outcomes and make programs like Medicaid and Medicare solvent (guess, that’s challenging when your wallet keeps growing fatter and fatter otherwise). There must be a better definition of quality in healthcare which creates standards with accountability and incentives (in the beginning), for all those named above – a lofty thought because we are in so deep that whatever is done will only scratch the itch temporarily as the infighting is embarrassing for America.
Lorraine Mercado February 22, 2011 at 01:00 AM
Lorraine Mercado Thinking about the government to step in and control the cost of health care would be a great idea. Maybe instead of cuts to education maybe we should have cuts to governmental spending on first maybe their own health care policies. My father has Medicare and a supplemental insurance he pays for out of packet. That is over $2000.00 a year extra the cost of policy. A man 85 years old who thought he who live the good life after retiring at 65 has more expenses now than younger. Who is lowering his bills? I think we as the voice of the future should step in and let government know how we feel. If not we will be in worse shoes than my father when and if we reach his age.
Denise Bongiorno February 22, 2011 at 01:20 AM
The government will never come to a common ground regarding our health care system. The present systems we have now with Medicare and Medicaid are both financially a mess. And the people trying to decide whether it is quality, access or cost that will sway our new reform bill presently have the best insurance (for the rest of their lives). This insurance is not suited for any of us "commoners" though. I have always felt that solutions are created and become successful when there is buy in and team work with compromise to achieve the answer. The health care reform (if it ever happens) will never affect anyone in legislation working on these ideas at the present time.
Lois Schlussler February 22, 2011 at 02:33 AM
It is absolutely true that we as a nation need to start taking some personal responsibility on the habits we hold onto that effect the overall cost of health care as a whole. These including smoking, drug abuse, alcoholism, and over eating. But how can people be made more accountable? In reality this is very difficult. The taxes on cigarettes has a proven direct impact on the number of smokers in the US. This is important because the overall burden of medical costs that smokers put on Americans is extremely high and there's nothing wrong with trying to recoup some of these costs while trying to decrease the numbers of smokers. But what can we do about Americans other bad habits? At what point do we say the government is interfering too much? Very hard to say.....
Jill Snelders February 22, 2011 at 03:12 AM
I agree, there should be personal accountability. Even as they move forward with ACO's there must be patient incentives in order to get everyone working toward the same goals. You would think that personal health and well being would be enough of an incentive? When is personal choice and accepting the natural consequences for ones decisions enough?Perhaps we should develop personal health contracts where each individual agrees to take personal responsibility for their health in order to have the insurance.
Katheryn Metzger February 22, 2011 at 03:49 AM
I am very fortunate to have my employer cover a majority of my family's cost of healthcare. However, my friends that own small businesses are struggling with affording healthcare coverage. The cost is eating up their paychecks and forcing them to leave the work they love to work for companies that will pay for their benefits. What kind of consequence will this have on our community? Will being owned by the coporate world be just as bad as the government?
Reese Nolan O'Hanlon February 22, 2011 at 02:57 PM
The role of government in health care is a polemic issue between social conservatives who uphold the principles of an employer-based system or "market solutions," and the social liberals who advocate for government controls. The Affordable Care Act empowers our government to control the American health care delivery system. The unknown fate of this act is not the current "opinion" issue; rather the cost of health care is the real political issue that must be addressed by conservatives and liberals alike. Essentially, the piercing voice of the American people must be heard on this prevalent issue of the excessive cost of such care that is plagued with excessive, unnecessary, and wasteful expenditures in a recession economy that finds many Americans unemployed and financially insolvent. What factors have produced the astronomical costs in American health care? The answers range a gamut from unnecessary hospital admissions and readmissions, fragmented care, lack of coordination, variable quality, and administrative costs. Reform goals should target each individual's responsibility to implement preventive health care, and providers must take broader responsibility for patient are, outcomes, and resource use. Affordable Care Organizations are cost efficient and provide rewards for improved care coordination among providers. Also, ACOs put in place an infrastructure to support providers in improving quality and efficiency. Reese Nolan O'Hanlon
Reese Nolan O'Hanlon February 22, 2011 at 03:36 PM
Sorry! ACOs are Accountable Care Organizations, yet I really like the language in my "faux pas." It complements the purpose of ACOs! Reese
Lisa Tine February 22, 2011 at 07:54 PM
Government must have more control over the health care costs. This can be done in many ways such as putting more emphasis on public awareness. Encourage the nation to take an active role in preventing illness before the condition becomes chronic. Most of the nation makes poor food choices due to lack of knowledge and lack of funds to purchase healthier food. It is far less costly to make unhealthy food choices. With the proper media support, and education the nation may begin to make lifestyle changes. Perhaps they could add additional taxes to foods that supply poor nutritional contents. This shift of cost could prevent some chronic conditions that are so prevalent in United States and in turn bring the costs down. This change would also encourage greater personal responsibility.
Carol Reitz-Butler February 22, 2011 at 08:05 PM
Again and again I'm reading comments about pro-active wellness and preventative care. While this is very important, the truth is insurance premiums are crushing American businesses and employees, and co-pays can be astronomical. Not all health care expenses are caused by poor lifestyle decisons. My husband and I are in our early 60's; we lead active lives, make wise dietary choices and are healthier than most 30year olds. We pay high premiums and never make claims outside of routine yearly visits. My husband broke his wrist last spring, an event that could not have been "prevented", so far his care has cost us over $6,ooo in deductibles and "co-insurances", and the preponderance of paperwork generated by this relatively minor operation has been onerous. i pity those who are dealing with the crushing emotional burden of serious illness couples with the inefficiency and obfuscation evinced by insurance companies like ours.
Thomas Murphy February 22, 2011 at 11:08 PM
I agree with a lot of what was said in this article especially the personal responsibility part. You said that we should take personal responsibility and I agree. I think we should spend more money on preventing illness rather that treating it. We could spend money on educating and informing the public on to how to be healthy and the importance of it. Maybe if we focused on healthy living, in a few years we would see a decrease in medical spending. A healthy diet can deter obesity; heart disease and diabetes so why not start there. As you said, preventable chronic diseases account for a large percentage of our spending in health care so it seems to be a good place to start.
Victoria Salzone February 22, 2011 at 11:18 PM
I have become very discouraged with the people we elect and send to Washington. Our two party system is broken and ineffective Even those with the best of intentions are stalled and crippled by the political machine that crushes any hope of real change. Once elected many of these officials become politicians who are looking to do whatever it takes to get reelected. They lose sight of the true purpose of their responsibility which is to represent their communities and to be the voice of people. A true change in healthcare; costs and quality will not change with laws created in Washington. I t will only change when we the American people start making changes in our lifestyle, within our own families and in our own school districts. American families need to be responsible for their own lifestyle choices and realize that health care begins at home. The parents and caregivers need to set the example for children from a very young age. Families must become more educated in areas of nutrition, exercise, holistic medicine, medications, personal hygiene etc. We must become more proactive in our choices and work with the local school districts to make a healthy lifestyle part of the education curriculum starting in nursery school.
Matt McElroy February 22, 2011 at 11:44 PM
Nearly 1/3 of children ages 10-17 are overweight? Shocking, well not really when you consider that nearly 95% of kids in America can recognize who Ronald McDonald is. This iconic figure is targeted at children and is only fattening them up. I call for his resignation! The thought of holding people accountable for their health sounds like a good idea and starting early has to be the plan of action. Educating children on obesity and setting up fitness programs can prevent chronic disease for their generation but it’s a shame that these types of programs are usually the first to get cut in a schools budget...
Tifffany nendza February 23, 2011 at 11:46 AM
I agree that we should be accountable for our own health care with diet and exercise. Our culture want someone else to take the responsibility and that has allows fallen on the government. The government has not lived up to standards as well. I think it our culture as a whole that need a adjustment. Doesn't matter how many incentive we have, people are hard to change.
Marcia Carter February 23, 2011 at 12:57 PM
I believe the German System of Government run and private nonprofit health care systems running side by side is a good example of a system that works. The issue I think we have in the United States is we are looking for a one thing fixes all to solve the problem of a country that is as vast as it is diverse in not only location but its population of individuals. The needs of the people in the North East are so different to the needs of those in the Midwest.
Kate Fenton February 23, 2011 at 02:15 PM
The ACA healthcare reform has focused too long on insurance reform, with all of the resources going to access and increased services. Reform in quality, including patient education and support, coordinated care, and individual responsibility must take place for healthcare in the United States to stop spiraling out of control. Government involvement should not focus on mandating insurance purchase and access alone, preventative education imperative and is often one of the first programs cut during difficult economic times. The Department of Health and Human Services Public Health incentives have been grossly underfunded. Perhaps the government should “tax” the large for profit insurance and pharmaceutical companies to help offset the funding of educational programs targeted at the at risk population. The ACA is a band aid to a cumbersome, highly politicized health care system; its greatest achievement is bringing the problem to forefront of the American Public’s attention. The first step in reform and recovery is admitting there is a problem, now we all must become educated, active and responsible “consumers” as we weed through the mess.
michelle cheslak February 23, 2011 at 09:12 PM
This current healthcare system is a mess ! We hear constantly about the different ideas and suggestions for the future of our healthcare system. Politicians continue to agrue of what should be implemented in the healthcare system. You can call my glass half empty, but this feels like an ever ending debate of healthcare. I agree that the future rest in the hands of educating the people and taking into personal account of our own health. The price of cigerettes has increased, why not increase or put a high tax on the fast food and unhealthy foods. Yet we all have ideas how to fix it and we continue to eat at mcdonalds.
Louanne Charles February 25, 2011 at 08:39 PM
Sometimes the saying "If it ain't broke don't fix it" is irrevelvant. We should look to resolve issues before they occur. From both a political and individual perspective, we need to take a greater approach to prevent problems even if there is no major concern. I try my best to be as "health conscious" as possible and it is often taken offensively by others because I eat right size portions, drink lots of water, consume fruits and vegatables from time to time, and try to get enough exercise. However, because I am of moderate size for my height, or what some would consider small framed, and do not have any major health issues, negative comments are often made like "are you on a diet?" and "why do you need to exercise?". You see the misconception is that only people who are heavy/overweight or have major medical concerns should watch what they eat and exercise regularly. The reality of it is that this is the type of society that we have grown to accept. It is time for use as individuals to take the first step in the betterment of our lives and of our health overall. Let's not wait until something is wrong to try to find drastic ways to resolve it - at mot times, when its already too late. As for govenmental influence, just as they have pay-for-performance incentives for physicians who actually meet their guidelines, maybe its time to have a pay-for-initiative incentive for individuals who follow recommended governmental guidelines for preventive care.
christine diah February 26, 2011 at 12:46 AM
It is sad that so many americans are without health insurance coverage especially those with challenging medical conditions but as the health care reform takes effect, we hope that this will change . Most of the HMOs will not support the reform and there are many people that oppose the reform. So, helping the uninsured to get health care coverage will always be a challenge in this country.
Jeremy Engdahl-Johnson March 01, 2011 at 04:06 AM
What is the economic burden of diabetes? Proper mgmt and control could save 49,000 lives and $196 million annually. http://www.healthcaretownhall.com/?p=2699

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