Achieving Universal Health

By Erika Kimball, RN

My last article explored four flaws in the American health care system highlighted in a panel at this year’s Net Impact conference. During the panel, the speakers briefly touched on another very important aspect of health care reform, the need to decouple health from health insurance coverage. While universal health coverage is the right of every American, universal health should be the goal of reform.

Health and health coverage are by no means mutually exclusive. Approximately 16 percent of Americans lack health insurance. According to a study by the Kaiser Family Foundation, uninsured patients receive approximately one-half the medical services that insured patients do. They receive less preventative care and seek treatment for conditions at more advanced stages. This care is generally delivered at a hospital, the most expensive and dangerous setting for health care in America, resulting in higher mortality and morbidity rates. Herein lies a true example of class warfare in America. Universal coverage must be implemented in the United States, but this only remedies how we pay for care. Real health care reform must remedy our current system’s inability to deliver health.

At $4500 per citizen per year, the United States tops the list of health spending worldwide. Life expectancy, on the other hand, is 27th in the world. In a stunning comparison, at $128 per citizen per year, life expectancy in Cuba is 28th in the world. Thanks to the long-standing American embargo on Cuba, the country has had little access to medical technology and pharmaceuticals, resulting in a health care system that relies heavily on prevention, wellness, and complementary and alternative medicine. If we’re achieving the same outcomes as Cuba, then why are we investing 16 percent of our GDP in an intervention-heavy system that’s not delivering? Because health care in the United States is a major industry that depends on throughput for profit generation. We’ve created a monster that has lost sight of its primary stakeholder, the patient (that’s you and me).

So how are American patients doing these days? Apparently, not very well. A 2007 Milken Institute study estimated that 50 percent of Americans suffer from one or more major chronic diseases. Linking personal health to economic health, treatment of these conditions cost $277 billion in 2003. The real economic impact, however, is the estimated $1 trillion in indirect costs of chronic illness: lost productivity from sick days, presentee-ism (workers that show up sick on the job), and missed work by caregivers. The study found that simple actions such as weight control, good nutrition, exercise, smoking cessation, and early disease detection and treatment would result in an estimated 40 million fewer illnesses with a savings of $1 trillion annually by 2023.

This study describes both the incentives and basic directions to improving health in the United States, but "simple actions" such as nutrition and exercise aren’t always so simple. Many Americans have little time or money to dedicate to wellness in a society structurally predisposed to sedentary lifestyles and fast food, linking personal health to higher socioeconomic status. This is where our greatest opportunity for positive impact lies: enabling and empowering all Americans to claim their universal right to health. The Prevention Institute promotes the total causes of health in the United States, as progressive organizations heed their call to create healthy communities through healthy food, safety and violence prevention, and socioeconomic equality. These bottom-up efforts combined with policy reform are laying the groundwork for a healthier America. Support for universal health improves health outcomes for everyone, including the insured, fostering economic resilience and better communities. What work is being done to improve health in your local community?

**Erika Kimball is a Registered Nurse and a Sustainable Business Professional dedicated to minimizing the environmental impacts of the health care industry.  She is founder of the Green Team at California Pacific Medical Center and has an MBA in Sustainable Management from Presidio Graduate School.