President Obama and Governor Christie: A Model of Cooperation for Protecting Public Health

It took Super Storm Sandy to remind us how much we need our government. And how rarely we see government leaders truly cooperate.

Cooperation has been a dirty word in politics for close to two decades.  But in responding to the crisis caused by Sandy, President Obama and Governor Christie showed us that political adversaries are at their best when they work together to meet our needs.

It took an environmental holocaust for this to happen.  But as the pictures of destruction in state after state circulated throughout the media, no one talked about privatizing FEMA.  No one complained that the government was spending too many taxpayer dollars rescuing people from death. 

It was a fine way for the President to end his first term in office – one that may ultimately have won him his re-election.  And also won him a new opportunity to collaborate with the states.

In the storm’s aftermath, we understand that one of the prices of having the freedom to live where we desire – Queens or Greenwich, Staten Island or the New Jersey Shore, Hoboken or New Orleans, the West Virginia mountains or the central plains – is that we must protect our living environment.

We understand that no place is safe from sudden destruction.  So we need all levels of government – and they need our support – to build better flood berms, hire more first responders, and put in place pumps and sewers to get polluted water more rapidly out of streets, subways, and homes.

And to prevent such catastrophes in the future.

God only knows if Sandy itself was caused by preventable climate change.  And it’s not really worth arguing anymore with people who deny what they see with their own eyes – that our weather has changed dramatically over the past few years.

What no one can deny is that we have been lax in our preparation for catastrophe.  We have been lax in investing in the infrastructures needed to clean up and repair the devastation.  And we have been lax in investing in the infrastructures that can prevent such catastrophic damage in the future.

This time, the crisis was in the northeast.  In recent years, the central plains and gulf coast have experienced similarly horrifying environmental catastrophes. 

No one knows who will be next. But we all know someone will be next.

So we need to prepare.  And this means strengthening our public health infrastructure.  That infrastructure:

• Prepares for and organizes our response to natural disasters.
• Makes certain we have access to emergency services.
• Handles pollution control and abatement, decreasing our negative effect on our environment.
• Enforces our building codes.
• Prevents environmental and health disasters every day.

We have let this infrastructure go during the last few years, with deadly consequences.

• Local and state health departments have lost over 55 thousand workers to budget cuts.
• In New York and New Jersey alone, over half of local health departments lost jobs due to budget cuts in 2011.
• Almost one-quarter (23%) of local health departments nationwide have reduced or eliminated emergency preparedness functions. 

Robert Pestronk, Executive Director of the National Association of County and City Health Officers (NACCHO), predicted what would happen  almost a year ago, when he said “at this critical juncture of dwindling funding and difficult choices, health departments are now doing less with less.  Budget cuts and a declining public health workforce challenge their ability to protect the health and well-being of all people in their communities.”

How well the people of Staten Island and scores of other communities understand this now!

Despite the closeness of the election, Barack Obama has a mandate as he enters the next four years.  It is to continue the bi-partisanship that served us so well at the close of the campaign season.

And governors like Chris Christie have a new mandate, too – they need to rebuild public health infrastructures in partnership with the federal government, no matter what their Congressional representatives may say or do. 

As we continue to pray for our most recent victims, let us hope – for the good of all – that in the coming years our leaders heed these needs, and tackle together all the real crises that command our attention as a nation.

And let us hope that rebuilding the infrastructure that has been devastated as much by budget cuts as it was by Sandy will be at or near the top of the list.

If you would like to arrange for Paul Gionfriddo to speak to your group or organization, or have questions about this column, please send an email to gionfriddopaul@gmail.com.

The War on Health

Policymakers across the country have declared war on health.  You may have missed the headline, but this is a war with many casualties.

Its objective is to topple health care as we know it.  When health care falls, our health will be the victim.

Battles are raging in many states to cut the legs out from under health care financing.

The Arizona Senate Appropriations Committee recently voted to eliminate the Medicaid program.  This would make 1.3 million people uninsured and cost the state $7.5 billion in federal funding. 

A Florida Senate leader has threatened to eliminate Medicaid unless the federal government agrees to massive changes.  This would cost Florida over $10 billion, and make 3 million people uninsured.

Wisconsin’s Governor has proposed dropping over 60,000 people from Medicaid because they are too rich.  “Too rich” means a two-person household income of less than $29,100.     

Medicaid isn’t the only target. 

Pennsylvania just cancelled its state-funded health insurance plan for low income residents.  As a result, 42,000 people lost their insurance.  A half million more on the waiting list have to fend for themselves.

New Jersey’s Governor proposed a 15% reduction in state health appropriations this year, six times greater than the overall reduction in his budget in his recent speech to the Legislature.

Florida’s Governor proposed eliminating state-run health department clinics, even when they generate revenue.  In Palm Beach County alone, this would cost 60,000 people their regular source of care.    

This war began quietly while the eyes of the public were focused on federal health reform.  The Center on Budget and Policy Priorities has detailed a number of battles we have already lost:

• New Jersey lowered income limits and reduced eligibility for the state’s Children’s Health Insurance Program.  50,000 more people are uninsured as a result.  
• Mississippi reduced its mental health budget by 22% in the last two years. 
• Illinois and Ohio cut community mental health services for children and reduced or eliminated community mental health services for adults who are not on Medicaid.

Elected officials declared this war on health by suggesting that health care was the weapon of mass destruction of our state economies.  It wasn’t.  The real weapons were the war in Iraq and Afghanistan at a total cost of over $1 trillion (and counting), for which the federal government did not have the courage to pay, and the greed of a financial industry which fattened our burst housing bubble. 

Health care is not a foe of the state, and people who need it should not be treated as enemy combatants.

However, people with mental illness are this war’s prisoners, often jailed instead of given the care they need.  This is not an exaggeration. The three largest mental health institutions in the country are Riker’s Island, the Cook County Jail, and the Los Angeles County Jail.  The largest mental health institution in Texas is the Harris County Jail.  It has 2,400 “patients” on any given day. 

In 2011, Texas is considering cutting $1.1 billion from state mental health services.  

According to the US Bureau of Justice Statistics, in 2005, more than half of over 2 million prison and jail inmates had mental health problems.    Over 1.25 million Americans are being “treated” for mental illness in our prisons and jails.

Elderly women and children are this war’s hostages. 

The Medicaid program funds 68% of the 1.8 million nursing home beds in the U.S.  Almost a million people live their lives in these beds.

650,000 of them are women, the vast majority over 75 years old and widowed.  In his recent speech, New Jersey Governor Christie articulated a fearful future for them.  Others share his vision “to move our aged, blind, and disabled [Medicaid] recipients into modern managed care.” 

These sick, elderly women suffer the indignity of being blamed for the state budget crisis they had nothing to do with creating.  If the Governor’s vision becomes reality, they won’t just have to cope with incredible health challenges.  They will be put at the mercy of the discredited “modern managed care” denial system.

Mostly under the radar, 31 states have already implemented cuts in children’s health programs.  As representatives of the Iowa Child and Family Policy Center and Voices for America’s Children note in their recent publication, The Healthy Child Story Book, for the first time in our history children may live shorter and less healthy lives than their parents.

Meanwhile, legislative bodies in Ohio, Louisiana, and Arizona have found the time to pass laws banning animal-human hybrids.  This is no joke.  The Louisiana bill’s sponsor, State Senator Danny Martiny, said the Louisiana Conference of Catholic Bishops asked him to introduce it.    

Louisiana ranks 49^th among the states in health, ahead of only Mississippi.  While imaginary beings occupy the attention of political and religious leaders, this war will produce millions of all-too-real casualties.