We're cattle, not cowboys
By: Kelsey Schuette
Issue date: 11/6/09 Section: Opinion
You might say it's because this particular healthcare reform bill is about insurance, not health-and you would, at least in part, be right. S. 1796 is certainly about regulating the healthcare insurance industry in this country: who gets coverage, for what cost and for whose remuneration. Discussions about insurance and discussions about health, however, are not as separate or dissimilar as you might think. Multiple studies have documented that insurance can drastically affect the healthcare a person receives and the health outcomes they experience. Furthermore, population level analysis is just as inherent within the logic of insurance as it is in health and healthcare. Insurance is about spreading risk over a large pool of people; it's about how much money each person has to pay in to cover the rare but large costs that may (or statistically speaking, will) befall members of that group. As Roberts might say, it's about how many head of cattle you need to sustain the ranch, accepting the fact that one or two are going to bite the dust (or wander out of the box canyon). Economists fretting about healthcare and the federal budget, or insurance companies concerned with pharmaceutical bargaining power, will tell you the same thing: when examining America's health and healthcare from a public policy level, it's the macro level that matters.
So why do books, newspaper articles, television programming, documentary film and even presidential addresses regarding this issue focus upon the stories of individuals? Why is the impetus for reform framed within sob stories and predicted outcomes articulated in terms of "how will this affect me?"
These are not trivial stories or invalid questions. Healthcare narratives can help Americans feel connected to an otherwise rather intimidating amount of legislative jargon. The dominance of such individualistic discourse, however, ultimately obscures the real questions Americans should be asking about this healthcare reform. Questions like, does this reform safeguard the health of our population-by ensuring access to accurate health information, to vaccinations, to the treatment of infectious diseases, to programs addressing the epidemics of tobacco use, obesity and alcohol abuse in this nation? Are we maximizing the insurance industry's ability to spread risk over a large number of people, and increasing their bargaining power with pharmaceutical companies for lower drug costs? Are we optimizing our labor workforce by effectively managing chronic conditions? Are we creating a system that will incentivize safer drugs? Food? Environment?
So why do books, newspaper articles, television programming, documentary film and even presidential addresses regarding this issue focus upon the stories of individuals? Why is the impetus for reform framed within sob stories and predicted outcomes articulated in terms of "how will this affect me?"
These are not trivial stories or invalid questions. Healthcare narratives can help Americans feel connected to an otherwise rather intimidating amount of legislative jargon. The dominance of such individualistic discourse, however, ultimately obscures the real questions Americans should be asking about this healthcare reform. Questions like, does this reform safeguard the health of our population-by ensuring access to accurate health information, to vaccinations, to the treatment of infectious diseases, to programs addressing the epidemics of tobacco use, obesity and alcohol abuse in this nation? Are we maximizing the insurance industry's ability to spread risk over a large number of people, and increasing their bargaining power with pharmaceutical companies for lower drug costs? Are we optimizing our labor workforce by effectively managing chronic conditions? Are we creating a system that will incentivize safer drugs? Food? Environment?
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