First, I didn't say I agreed with everything in the article, I just thought it might be a useful starting point for actual discussion of an issue, out of fashion though that might be on this thread. I certainly don't believe in the sort of government involvement in health care that Hillary proposes, but I do think that for practical reasons there is a real role that government must play. It is disturbing to see the discussion framed in "all or nothing" terms, when intelligent policy almost certainly lies somewhere between those extremes.
The problem posed by illegal aliens is a case in point. It is certainly objectionable to spend government money to provide health care to people who shouldn't be there in the first place. It is downright dangerous, though, to have large numbers of people with communicable diseases walking around on the streets. Immigration policy and enforcement are not under the control of public health officials; if they have to treat illegal residents to protect the health of legal ones, that's what they have to do.
The problem of uninsured people, children in particular, is also more complex than it initially seems. It is easy to say that people who won't take the trouble to insure themselves should be left on their own. The problem is that they aren't left on their own: their problems fester until they become critical, and they end up in emergency rooms, which are the most expensive places to provide care. It is often much cheaper in the long run to bite the bullet on cost and aggressively deliver more cost-effective primary care.
The parts of the article - which took some care to make clear that many of the problems existed before Bush took office - that interested me:
Dr. Archer explained why the state tolerated having 598,000 children eligible for Medicaid, the federal-state health plan for the poor, but not enrolled in the program: "The problem is that the Legislature knows that if we are successful, and we got all those kids registered, they would not balance their budgets any more. It's not one person saying, 'Don't do this.' It's not one agency saying, 'Don't do this.' It's sort of 'Why would we all rock the boat at this point?' "
Except for Dr. Archer, most prominent health experts in Texas see the low insurance rates as the state's biggest health problem. Clair Jordan, executive director of the Texas Nurses Association, said, "Uninsured children end up in the most costly place, the emergency room."
....
In 1998, 39.1 percent of Texans under 18 living at no more than twice the poverty level lacked insurance, compared with 25.7 percent nationally. In 1994, 36.7 percent of poor children in Texas and 22.8 percent of poor children nationally were uninsured.
There are many reasons for the low rates of insurance, including migratory labor, a large rural population and many low-wage workers in nonunion jobs.
But the single biggest reason is probably the state's Medicaid program, which has some of the nation's most severe limits and complicated eligibility rules and thus makes Texas "one of the most difficult states for someone to figure out how to get enrolled," said Diane Rowland,
executive vice president of the Henry J. Kaiser Family Foundation, a research organization.
I also thought it interesting that while the State's high rate of teenaged pregnancies is often attributed to different cultural assumptions amont the Hispanic population, the rate among white teenagers is also one of the nation's highest.
There is no doubt that Texas is a special case when it comes to health care: it shares an extended and highly porous border with a Third World country, and many communities on the US side of the border present living conditions and health profiles that are close to Third World levels. One might reasonably expect, though, that a State which faces such unusual conditions would be making unusual efforts to deal with them; I'm wondering if that is in fact the case. |
