Monday, January 22, 2007
The state of health care
Tomorrow night, President Bush will deliver his seventh State of the Union address. Call me a nerd, but I have watched every State of the Union since I was 5. I'm proud to say that I have never missed my annual checkup with the president. After all, the State of the Union is a unique public opportunity for the president to lay out his agenda for the upcoming year and to point to accomplishments of the last. To oversimplify, it's a summary of the year in the White House.

In that spirit, here's a very brief look at some of what Bush has said about health care in the State of the Union since he entered office:

2001: Medicare is a top priority: "No senior in America should have to choose between buying food and buying prescriptions."

2002: Tax credits and Medicare float to the top: "I ask Congress to join me this year to enact a patients' bill of rights - to give uninsured workers credits to help buy health coverage - to approve an historic increase in the spending for veterans' health - and to give seniors a sound and modern Medicare system that includes coverage for prescription drugs."

2003: Bush surprises many in AIDS community with a $15 billion commitment over 5 years to fight global HIV/AIDS with special mention of Africa and the Caribbean.

2004: Of all of his state of the union addresses, the president spends the most time this year on health care. He proposes tax-free health savings accounts and 100 percent deductible catastrophic health care premiums.
"A government-run health care system is the wrong prescription. By keeping costs under control, expanding access, and helping more Americans afford coverage, we will preserve the system of private medicine that makes America's health care the best in the world."

2005: Tax credits and health savings accounts headline again. The president also addresses the ethical issues of embryonic stem cell research.
"I ask Congress to move forward on a comprehensive health care agenda with tax credits to help low-income workers buy insurance, a community health center in every poor county, improved information technology to prevent medical error and needless costs, association health plans for small businesses and their employees - expanded health savings accounts - and medical liability reform that will reduce health care costs and make sure patients have the doctors and care they need."

2006: Familiar themes: insurance coverage expansion, medical liability law reform: "We will make wider use of electronic records and other health information technology, to help control costs and reduce dangerous medical errors. We will strengthen health savings accounts - making sure individuals and small business employees can buy insurance with the same advantages that people working for big businesses now get. We will do more to make this coverage portable, so workers can switch jobs without having to worry about losing their health insurance. And because lawsuits are driving many good doctors out of practice - leaving women in nearly 1,500 American counties without a single OB/GYN - I ask the Congress to pass medical liability reform this year."

As we prepare to cover tomorrow night's speech, we already know the president will propose tax reform designed to make basic private health insurance more affordable. It's no surprise, considering he's mentioned insurance coverage in every one of his yearly check-ups with American citizens. To be fair, health care coverage is a huge issue and there is no quick or easy fix. But with only two years left in office and a Democratic Congress, one question this year is whether he'll be saying the same things next year.

What do you hope to hear from the president tomorrow night? Do you think he and Congress have achieved any of their previous health care goals?
The healthcare solution in the US is extremely complicated. In my studies I have discovered that private healthcare (no matter the proportion of private/public) will always leave the vulnerable and underrepresented behind. Social healthcare is unlikely to succeed because Americans are not willing to wait for services and pay for other peoples' poor health decisions. There is no doubt, that the organization of our healthcare system is incredibly complex, difficult to navigate, and disgustingly expensive -- the US spends more dollars per capita on health care for its citizens than any other country (and still...over 45 million are uninsured) yet our nation's health definitely does not top the charts. Our access to the newest and most recent biomedical technology is the greatest in the world; yet we still suffer from poorer health compared to many other developed countries. Even Cuba, which has a tiny fraction of the resources that we have in terms of technology, has better health outcomes for many of the major health indicators.

This points to my dilemna. Right now, the American people aren't ready for a socialized healthcare agenda; and I don't think a privatized system can fix our problems of uninsurance and healthcare inequalities. In my opinion, our leaders need to focus on promoting health and preventing disease in the first place. Increasing our physical activity, eating less processed foods, and spending more time helping others and relaxing our mind and spirit will prevent disease better than any magic pill -- and once you need medical attention, it is too late.

I hope President Bush encourages the American people to take control of their health, not by putting extra money into technology and medical care (although, those are still important fields), but to stand confidently behind activities of disease prevention. Let's get healthy so we don't get sick in the first place. Then we might reach that #1 ranking for health outcomes in the world.
Get a behind-the-scenes look at the latest stories from CNN's chief medical correspondent, Dr. Sanjay Gupta, and the CNN Medical Unit producers. They'll share news and views on health and medical trends -- info that will help you take better care of yourself and the people you love.
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