Health Policy: A Prescription for Listening

Salus populi suprema lex esto. These words declaring “the health of the people should be supreme law,” are engraved above majestic marble steps leading up to the Missouri State Capitol. Though I read these words many years ago, I still remember them filling me with awe as I prepared to meet elected leaders of my home state. Now, as a physician in the midst of an unwieldy, unaffordable health system and the debate over its reform, I return to these words to find direction and purpose.

Since the passage of the Affordable Care Act (ACA), state lawmakers have met under these words to debate health care policies such as insurance regulation and Medicaid expansion. And regretfully, like in many state capitals and in Washington, D.C., the heated monologues and dialogues have forged little compromise, much less any consensus. The rising cost of healthcare, physician shortages, and an increasingly older and chronically-ill population have driven a growing sense of scarcity in this country. But this hyper-intense focus on cost places us deeper in the same quagmire, as those with resources grow tired of shelling out for programs they view as charity with little return on investment. Until we also acknowledge the ethical and economic importance of human welfare as a public good, even the most well-designed policies will never become law or will be so altered by amendments or back-room deals that they miss their intended mark.
Instead of doubling down on well-worn talking points, the conversation needs to take a new direction focused on listening to each other. First, we must admit that leading healthy lives in this country is difficult. Long hours at desk jobs, food deserts, and an opiate addiction epidemic are just a few of the challenges the average American faces. And we all have a story of our own where medical care or an important medicine was forgone due to cost or inaccessibility. Second, we must acknowledge that responsibility for one’s illness or state of need should not preclude access to affordable life-saving or life-preserving care. In fact, the larger share of evidence suggests the punitive approach to policy or treatment creates more problems than it cures. And third, we must work to improve transitions of care at the end of life, which is much more about improving societal preparedness for death and dying rather than rationing care.

These principles are not meant to be prescriptive for improving health policy, but I believe they will lead us to greater awareness of our own humanity and fallibility, which is a sound starting point for a dialogue on improving health and healthcare. These principles also lend more dignity to the destitute, dependent, and dying. In fact, listening to their stories will create value through reinforcing equality and interdependence. Put simply, just societies are healthier societies. For example, there is a growing body of evidence suggesting that income inequality confers a higher risk of mortality to all members of a society, not just the poor. And with all the concern about rising health insurance premiums, it is crucial to realize that insurance works best –and with lower cost—when risk pools are balanced with sick and non-sick. None of this is about charity; this is about recognizing that the health of our country is already inextricably tied to that of the marginalized. 

So let us challenge our lawmakers to listen more, de-politicize health, and drop the divisive language surrounding who deserves government assistance with healthcare. Let us also continue to hold government programs such as Medicare, Medicaid, and VA Hospitals accountable for the billions they receive and the millions they serve. And let the health of all people be our supreme law.

Sky Vanderburg, MD, MPH
September 2016