House Speaker John Boehner said recently that Congressional Republicans will have to face raising the debt ceiling as “adults,” echoing his March, 2010 comment that they needed to behave like “grown-ups” when health reform passed.
The passage of health insurance reform in 2010 did not solve all of our health policy problems, but passing a meaningless repeal measure in the House in January isn’t the best way for members of Congress to start putting their grown-up pants on.
What might an actual adult health policy agenda look like in 2011?
First, federal and state officials would put more resources into public health. Like computer anti-virus programs, public health programs work in the background, taking care of us even when we fail to take care of ourselves. They make sure our water is pure, our neighborhoods clean, our hazardous wastes are disposed of properly, and our children are immunized. People can argue over whether various prevention initiatives cost more or less than treatment but no grown-up can deny their effectiveness.
Except, perhaps, some public officials. Florida’s new governor is proposing to reduce the state’s commitment to public health by folding the State Health Department into the agency that manages the health care system. “Potato salad,” is what an AFSCME representative called this approach. More like mystery meat, I think.
Second, everyone should get a $100 tax credit for athletic equipment. If we’re going to stimulate the economy with tax cuts, why not stimulate a culture of wellness? Taking $30 billion of the trillion dollars we’ll spend on health care reform in the coming decade and giving $100 to every citizen for a new pair of athletic shoes, a down payment on a bike or treadmill, a first baseball glove, or other athletic equipment adapted to their needs, would make a meaningful, adult policy statement about the importance of fitness in all our lives.
Third, legislators should require periodic mental health screening as part of the well-care exams of children and young adults. Serious mental illnesses hit young people disproportionately, and hit them as aggressively as cancers, taking 25 years or more off their lives. (See the accompanying chart and the bottom of my Health Facts and Sources page for explanations about the comparison.)
We can treat most mental illnesses effectively if we treat them early and aggressively, but we often wait until it’s too late. One 20 minute mental health screening every five years from age five through age 30 is all it would take to get started, and we’d be on the road to a healthier nation.
Fourth, mental illnesses should be treated like other chronic diseases, not hidden away in jails. Would anyone support sending people with uncontrolled diabetes to jail when they go into a diabetic coma because they are being a danger to themselves? It sounds absurd, but that’s how we treat a significant percentage of the over 25% of us diagnosed with a mental illness every year. In 2007, Time magazine reported that the country’s largest psychiatric institution was a prison. Others have estimated that the majority of the people in our jails have mental illnesses. While almost any alternative would be preferable, the simplest solution is to de-criminalize mental illness, adding more community mental health services and centers and funding them adequately.
Fifth, state and federal policymakers should pass laws de-criminalizing casual drug use and drug addiction. Pat Robertson suggested this on his show on December 16, 2010, joining a growing chorus of others, including the Justice Policy Institute, who argue that drug treatment is far better and less expensive than incarceration. We’re still fighting and losing Richard Nixon’s War on Drugs, yet those who were born the year he declared it are turning 40 this year. It’s time for a change. Controlling the use of other drugs, like marijuana, the way we control prescription drugs, alcohol, or nicotine is not the same as being “for drugs,” and it’s a far more mature response to the situation we're in than hiding our heads and wishing the drug monsters away.
Sixth, Federal officials should expand the Medicare program to give everyone a medical home and pay for their free annual physical. Wouldn’t this be a great birthday present for policymakers to give to every citizen – a partnership for health? Congress went part way there in 2010 by including a free annual physical in the Medicare program, but this should be available to everyone, whether or not they’re privately insured. If it’s too scary and “big brothery” for some public officials to take this one on, then at least they should provide a tax credit for people to use to pay for it themselves.
They’re now reading the Constitution in Congress. I hope they don’t skip over the part of Article One Section 8 that reminds Congress of its duty to provide for the general welfare – meaning the health, happiness, prosperity, and well-being of our people.
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