Health Care Challenges Extend to Our Homes

Health policy debate over the past few years has revolved almost entirely around who pays the bill. The implication is now that Congress has passed the Affordable Care Act, the insurance exchanges, mandatory coverage rules and Medicaid expansions prescribed by the act have solved the nation’s health problems.

Or at least that was implied by proponents of the law, which has plenty of critics.

Sure, we need to get some more health care providers. The ACA has some provisions for that. People need to take better care of themselves, and the ACA establishes some programs to help there, too.

Mostly, though, our actions as a nation suggest that now that we’ve figured out how to get an extra 40 million people insured, we’re done.

Not even close.

The health of a nation consists of the health of its populations. There is much more to having a healthy population than financing medical care.

Robert L. Williams, who runs the University of New Mexico Health Disparities Center, was a physician working in western New Mexico primarily with Navajo patients. One cold night a family brought their unconscious child to his clinic. The child had been poisoned by carbon monoxide. This was the first of several children Williams saw that winter suffering from carbon monoxide poisoning. Some of them died.

It took a while, but Williams and his colleagues figured out that the children were being poisoned by emissions from defective car heaters. His patients’ parents didn’t have enough money to properly maintain their cars, and in that wide open part of our state people spend a lot of time in their vehicles. Carbon monoxide settles, so the parents were breathing relatively good air while their cars filled with poison below an adult’s nose level. The children were small enough to be engulfed. Some even sat on the floor where the gas would concentrate.

The solution was to fix the car heaters, but few had money to do that. The next best solution was to drive with the windows open.

Public health experts have long understood that where you live, how poor you are and your ethnicity have a great deal to do with how healthy you are, even if you have some form of health care coverage.

A coalition of experts, many of them affiliated with state and county health departments, have formed the Bernalillo County Place Matters Team to investigate how and where people live affects population health. One paper the team presented at the recent New Mexico Public Health Association conference said the Bernalillo County census tract you live in can make a difference in life expectancy of as much as 28 years. People who live in areas of Bernalillo County with the greatest concentration of environmental hazards — things like excessive diesel exhaust or contaminated groundwater — can expect to live 5.2 fewer years than people who life in cleaner environments. The Mountainview-San Jose areas of the county’s South Valley along South Broadway and Second Street host farms of gasoline storage tanks, junk yards, warehouses, the old GE aircraft factory, a couple of Superfund Sites and lots of big trucks. Place Matters found that the people who live in the area suffer significantly more heart disease, cancer, strokes, pneumonia, kidney disease and other serious health problems than the county as a whole.

A friend of mine who used to work for one of the Medicaid managed care companies explained the Medicaid program to me this way:

A family whose kids are qualified for benefits shows up at the Medicaid office. Someone hands them a thick folder that explains their benefits. No one reads it.

Soon enough one of the kids shows symptoms of asthma. His parents take him to the doctor. A cycle of medical treatment begins, punctuated with occasional panicked visits to the emergency room with a child who can’t catch his breath. Thousands of dollars are spent, and the child never really feels well. His school performance suffers. His mother may lose her job because she spends so much time taking him to the doctor.

Meanwhile, the mold in the kid’s bedroom wall that is causing his lung problems keeps getting worse because no one has enough money to repair the leaking roof.

Medicaid doesn’t pay for roof repair. The system of clinical care is not designed to identify a leaking roof, let alone repair it.

The United States spends trillions of dollars on health care every year. Much of that spending would be unnecessary if we could think of health as a total package and not as a succession of physician visits and an insurance card.

ACA is a beginning. Finding a way to pay for the care of millions of people is essential. But ACA by itself is not the answer.

— This article appeared on page A1 of the Albuquerque Journal