by Patricia A. Nolan
I was standing in the lobby of the massive 918-bed Cook County Hospital complex in Chicago when it finally hit me. Here in the heart of one of the country’s largest public hospitals I was surrounded by people from communities with poor housing, unemployment, poverty and crime. But lack of adequate health care also threatens these communities. I realized that planners who focus on community development are often concerned about physical and economic conditions, but I rarely hear much from them about the accessibility and quality of health care.
The vast and powerful health care system in this country has the ability to cure the sick and improve people’s lives in much the same way that decent and affordable housing, economic development and a cleaner environment improve lives. Elected officials talk about adequate access to health care for all. But as we approach the next century at least 41 million Americans will not even have health insurance. Doctors and health care providers will continue to treat a woman in labor three months early who had no pre-natal care, a man in shock from diabetes that could have been easily stabilized, and a child in fever from infectious diseases that were curable decades ago.
There are no signs that Congress will fix the system despite the talk of “health care reform.” The uninsured are not the only ones left at risk. The lack of will and leadership in Congress has ramifications for all citizens. The reasons for wide-spread concern are apparent in the policies crafted most recently by Congress:
• The uninsured are further threatened by a recently passed health insurance portability bill. This bill allows private health insurers to impose preexisting condition exclusions beyond twelve months, and does not guarantee access to the same benefits or limit the premiums that can be charged;• The new Children’s Health Insurance Program will cover less than half of the ten million uninsured children;• Medicaid recipients will watch states use greater flexibility to get around federal standards designed to ensure that low-income persons have access to comprehensive benefit packages. Now states can force Medicaid recipients into low cost Medicaid-only managed care plans with minimal federal oversight.• Medicare beneficiaries are at risk because total reimbursements to Medicare providers are capped based on previous utilization levels. This creates incentives for Medicare providers, like home health agencies, to withhold care from persons in greatest need who are less profitable to serve.• Even people with private insurance are in danger as more employers tell them that they can only choose between two policies, neither of which covers basic needs in times of emergency or illness.
Planners need to deal with the connections between planning, community and individual health if there is ever to be adequate health care for all. Planners have the ability and skills to quickly document and analyze common factors in the health care debate. We will also have to examine the public welfare, psychological, and health implications of our social and physical planning work. Through such a process our voice will become stronger in the debate over the techniques, goals and products of public health policymaking. This will only happen if we are serious about improving the quality of life in our neighborhoods and cities. Or shall we wait for Congress?