What's at Stake for Health in the Budget Debates

The President, the Congress, and State Legislatures are struggling mightily through their budget debates as if the health of the nation is at stake.  It is. But not in the way they think.

Whether wealthy people will pay more or less taxes, young people will get fewer social security benefits, and the governments will get smaller are important considerations.

But they are only important to people who are healthy enough to care about them.

What about those who aren’t? 

source: County Health Rankings, 2011

If someone were to tell you right now that you had a medical condition that was going to take 25 years from your life, would cutting spending and giving corporations tax breaks be your top legislative priority?  Would you vote for anyone who made those a bigger priority than your health?

Here are some of the people whose life expectancy today is 25 years less than the norm:

• A person born with Down Syndrome.
• A person born with Cystic Fibrosis.
• A young person diagnosed in his/her late teens with a serious mental illness.
• A person who played professional football in his 20s. 
• A woman in her thirties with Stage 4 breast cancer.
• A man in his forties diagnosed with Lou Gehrig’s disease.
• A 50-year-old man or woman with advanced congestive heart failure.

I don’t imagine these people see the budget debates the way politicians do.  Many rely on public programs and government spending for their health.  Whether they are for or against health reforms, there is a reason they are so passionate.  It’s not the money.  It’s literally life or death for them.  The sicker they become, the more they choose life.

Most of the politicians voting to privatize Medicare and cut Medicaid, or to cut $600 million from community health centers as members of Congress agreed to do last week, don’t rely on these programs to help them live well.  Terms like “medically needy” mean nothing to them.  For people who are medically needy, on the other hand, the stakes are much higher. 

Significant percentages of Americans are living with serious chronic conditions that cost a huge percent of their monthly income and most of their savings.  These Americans witness government leaders who don’t realize that when they say share the “pain” of cuts, it’s a cruel joke on people feeling real pain. 

Health spending cuts come at a real price.

This year’s county health rankings were released a couple of weeks ago.  Palm Beach County, my home for the last six years, is ranked 11^th among 67 in the State of Florida – pretty impressive.  Only 12% of us are in poor health and, based on a calculation that adds up the overall harm this does to our life expectancy, we lose only 7.5 years of life to premature death for every 100 people.

Other south Florida counties also do well.  Broward County, which ranks 10^th in the state, loses only a little over 7 years of life for every 100 residents, and Miami-Dade, ranked 8^th, does even better, losing only 6.5 years.

By contrast, northern Florida counties have some of the lowest scores in the state.  24% in Baker County are in poor health, and they lose 11.5 years of life for every 100 residents.  Union County residents fare worst of all, ranking 67^th.  They collectively lose over 21 years of life to premature death for every 100 residents.

I was feeling pretty good about my county’s ranking until I compared it to the two counties in which I lived before I moved to Florida. 

Middlesex County, CT, ranks 2^nd of Connecticut’s eight counties, and its residents lose only 4.8 years of life to premature death for every 100 people.  Despite its harsh winter climate, only 10% are in poor health.

 Travis County, TX, ranks 6^th out of 223 Texas Counties.  Even though 14% of Travis County residents are in poor health, its people lose only 5.6 years of life to premature death for every 100 people.

Why should the health of Palm Beach County’s residents be demonstrably worse than that of Middlesex County and Travis County residents?  We’ve got our fair share of fine hospitals, clinicians, and public health services.  Historically, we’re not poorer than either of these two other counties – in fact, 10 years ago per capita income was about the same for all three. 

We also have lower taxes and less government.  Connecticut has a state income tax, and property taxes there and in Travis County are much higher than they are in Palm Beach County. 

But lower taxes and less government wouldn’t account for our poorer health status.

Or would they?