Yesterday, we posted part one of 2007-2008 Boston Schweitzer Fellow Zirui Song’s thoughts on health care reform. Here’s part two:
To truly address health care disparities, change must come within the health care system. That begins with recruiting and training a diverse health care workforce. Today, medical schools and residency programs across the country have implemented courses on cultural competency in an effort to deliver patient-centered care. Universal coverage is, in fact, an important component as well, since equality in quality must inherently begin with equality in access.
In addition, just as we closely monitor infectious diseases in epidemiology, a similar strategy must be taken with health care disparities, which requires maintaining data on care processes and outcomes across different populations and informing policymakers with appropriate evidence-based goals.
During my Schweitzer Fellowship year, in which I helped a community health center set up a sports and nutrition education program for kids, the mother of an 8-year-old boy helped me understand how the problems of our health care system translated into lives of ordinary people. While her son listened to our nutritionist, she explained that her ability to buy healthy foods and provide safe exercise for him were constrained by their low family income and their unsafe and similarly impoverished neighborhood.
Of course, she was uninsured. To know that a simple visit to the emergency room could amount to enough money for weeks of food off her table was a sure message that our health care system was broken. Looking back at her son, I wondered whether our volunteer work would pale in comparison to the seemingly insurmountable social obstacles that faced his family, or whether our limited afternoons in the gym and classroom were enough to leave him with some substantive understanding of a healthy lifestyle.
My Schweitzer Fellowship taught me that our health care system does not stand alone from the other institutions in our society. Health care, like education, law enforcement, public transportation, and political representation, is an intrinsically social service, even if its delivery must be market-based in a country like ours. It taught me that effective health care reform must be designed with health care’s sister institutions in mind; that providing health care coverage to all Americans would mean offering the uninsured some stability in their lives, if only as much as a primary care physician to call their own; that reducing health care disparities may lead to fewer disparities in education, also a meaningful achievement.
The Schweitzer Fellowship also taught me to remain actively engaged with the community, because amidst the statistics that merely describe our health care system—the 47 million uninsured, the 17% of GDP, the 55% of quality care actually delivered to adults in the United States—are real people and families that actually make up this health care system.
The inevitable human aspect of health policy cannot be forgotten. The story of health care reform is not told in dollars alone.
On the whole, I am encouraged by the current political debate over reform. It seems that Congress and certainly President Obama understand that the months ahead constitute an opportunity for meaningful reform that may not present itself again. Every previous effort by presidents to push for universal health care was followed, after its failure, by roughly 15 years of avoidance of the topic in Washington. With all eyes on health care and key stakeholders pledging their support, the current effort is indeed more encouraging than we could have hoped only a year ago.