One might anticipate that the question “what are the barriers to providing free health care in Philadelphia?” would trigger a thorough analysis of the various factors that could comprise health reform in our City. Such an analysis exceeds the page limits of this newsletter! Achieving health reform on a National level received much attention in the recent election and certainly ranks high on President Obama’s policy agenda. On a national, state and local level, the ideal goal is to ensure health care is available, affordable and accessible to all people who need it. Rather than embark on a detailed analysis of the nuances of our current health care system in Philadelphia, I offer the following points:
Health care is never free. The issue is how to optimally pay for it- who pays and how much? Currently, the majority of people obtain their health care through employer-based insurance plans. However, a significant number of people work in positions where no health benefits are provided, yet their incomes are too high to qualify for Medicaid. An increasing unemployment rate is further contributing to the growing pool of uninsured.
The cost of health care has increased exponentially over the past 10 years. Marked advances in medical technology coupled with an aging population and complex, often chronic, diseases have given rise to dramatic increases in the cost of health care. Many of the health care needs we develop come as a result of the choices we freely make or are forced to choose given our circumstances. Tobacco-related diseases and obesity, for example, are major contributors to morbidity.
Prevention is a key component of health care reform. While I agree that health care is a right of all people, preventing, where possible, disease in the first place is an important means of controlling health care costs while keeping more people healthy. It’s important to remember though, that the life circumstances of some people prohibit them from easily being able to make healthy choices. For example, in order to reduce obesity, there is a need to be able to purchase affordable, nutritious food throughout our City. Further, providing a safe environment for children is an essential support of their being able to enjoy outdoor physical activity. The point is that being able to access health care at no cost, while a major and critically important goal, is not the sole answer to ensuring a healthy population.
It is highly unlikely that a City alone can initiate a plan to ensure all of its residents receive “free” health care. Absent a federal plan, states may be able to initiate plans for statewide health reform. Vermont and Massachusetts are perhaps best known for their programs. Pennsylvania however, has been unable to move forward with health reform plans that would seek to provide coverage for all Pennsylvanians. While Governor Rendell has been trying to push his plan for health reform for some time, there is strong disagreement among individual health care providers, hospitals, insurers and the state legislature, among others. Not surprisingly, central to the disagreement is where the money will come from to support a statewide plan. In November, 2003, Philadelphians overwhelmingly voted “yes” to the following ballot question: “Shall Section 5-300 of the Philadelphia Home Rule Charter be amended to declare that because health care is an essential safeguard of human life and dignity, the City of Philadelphia Health Department shall prepare a plan for universal health care that permits everyone in the City of Philadelphia to obtain decent health care?” It’s of interest that when asked if the City should plan for universal health care, 75% of voters said yes. Providing such care is another issue. The planning process that occurred (http://www.phila.gov/health/), ultimately called for the formation of a health leadership partnership- essentially key stakeholders who could coordinate care for uninsured Philadelphians and best support safety net providers. While the document provides full information concerning the system of health care in Philadelphia, it has yet to result in a system of universal health care.
Philadelphians receive their health care through all of the “usual mechanisms.” Employer-based insurance, Medicaid managed care programs, independent insurance plans, and pubic programs (Medicaid, Medicare and the Children’s Health Insurance Plan known as “cover All Kids”). Uninsured City residents can receive free health care via the system of District Health Centers (DHC) that provides comprehensive care, including oral health care services. DHCs can also provide medications through on site pharmacies. In addition to those health centers run by the City, there are several independent centers that can also provide free care. The DHCs have contracts with area hospitals for additional outpatient consultant services that may be needed, as well as inpatient care. The City lacks a public hospital. The current demand for health center services is great and hence the waiting time for routine appointments and related services is often 3 months or longer. The DHC system is a lifeline for many Philadelphians but it cannot possibly handle the growing number of uninsured. Further, in the face of our City’s impending round of budget cuts, it is quite possible that DHC services will be reduced. Sometimes the only way to access needed health care is through local emergency rooms- hence hospitals provide a large amount of so-called uncompensated care.
In sum, there are multiple ways to finance health care and reform at the federal level is high on President Obama’s policy agenda. Only a few states have thus far been able to try to ensure that their residents have access to affordable health care through statewide plans and Pennsylvania is not among them. Without passage of a federal or statewide plan, provision of health care to all Philadelphians remains elusive. What is the most significant barrier to achieving health reform that assures quality health care for all along with an integrated prevention and wellness program in Philadelphia, in Pennsylvania and in the United States? We all are. Creating a fair system of health care that denies no one will ultimately require an entire retooling of our current system and all of us will no doubt be called upon to contribute in some way. There are many stakeholders involved, including insurers, providers, lawmakers, entire health care systems, employers and employees. Certainly the unemployed and uninsured also have much at stake. Understanding that together, we can create a healthier City, State and Nation and taking steps to do so moves us in a direction needed to assure conditions in which people can be healthy. Such assurance is the primary role of public health.
- Cultural Competency, Community-Based Organizations, and a Resilient Community Landscape-Important Elements of Philadelphia’s Health Care System By Raymond Lum, Professor of Health Management and Policy
- WHAT ASPECT OF HEALTH CARE DELIVERY IS MOST IN NEED OF REFORM? By Arnold Rosoff, Professor of Health Care Management and Legal Studies
- Behind Closed Doors: Insurance Companies and Clinton’s Health Care Plan
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