Focus on Health

During the last two years there has been an outcry from Tea Partiers and other critics about the Patient Protection and Affordable Care Act—which opponents have cleverly dubbed “Obamacare.” The focus of the criticism has been the mandate that everyone must have some type of health insurance. Critics call the mandate socialism. Supporters call it pragmatism.

What has been lost in the Sturm und Drang is any concern about health. By focusing on the mandate, critics have taken attention away from other important aspects of the act, such as its efforts to get the health care system to focus more on keeping people healthy and less on treating disease.

In this issue of the Stanford Social Innovation Review we are privileged to offer you a more thoughtful perspective on how to improve health care. Our cover story, “Realigning Health with Care,” is written by three prominent experts in the field—Rebecca Onie, co-founder and CEO of Health Leads and a Mac-Arthur Fellow; Paul Farmer, Harvard Medical School professor and co-founder of Partners in Health; and Heidi Behforouz, Harvard Medical School assistant professor and medical and executive director of the Prevention and Access to Care and Treatment Project.

The article makes a number of important points. The US health care system is in crisis. The United States spends far more on health care than any other country, yet Americans are among the least healthy people in the industrialized world. The United States ranks 36th in life expectancy and 46th in infant mortality. Health indicators in some US communities bear a striking resemblance to developing world nations like Bangladesh.

Two of the principal reasons that the US population is becoming less healthy, the authors assert, are a shortage of primary care doctors and rising poverty. Fewer medical students are becoming primary care physicians at the very time when more people are entering the health care system because of expanded insurance coverage. The number of people living in poverty, meanwhile, continues to climb. According to the US Census Bureau, an additional 2.6 million people fell below the poverty line in 2010, bringing the total number of people living in poverty to 46.2 million, the highest number in the 52 years that the bureau has been releasing figures on poverty. The links between poverty and poor health are direct and well known.

The situation looks dire, but Onie, Farmer, and Behforouz offer hope. As they point out, there are many examples around the world where innovative programs have improved health in the face of extreme poverty and limited resources. Partners in Health is a good example of what can be accomplished under dire conditions. Because there are so few doctors in Haiti, Partners in Health has trained other community members to act as health care liaisons. Health Leads, which operates in six US cities, has recruited 1,000 volunteers to work in hospitals and clinics, where they help low-income patients access resources such as food and housing, critical factors in people’s overall health.

The article is full of other examples of innovative approaches to health and a well-reasoned framework for how we can get our health care system back on track. Rather than retreat in the face of concerted attacks on efforts to expand health care to underserved people, it’s time for us to act.

Read more stories by Eric Nee.