Not much was overtly said about health system reform during the several hours of election coverage I watched on Election Day. None-the-less, American voters know that how we do health system business is unsustainable.
We can’t keep forking over trillions of dollars every year (mostly through our taxes) to support health care delivery that is poor quality, highly inefficient and leaves our patients in debt. The election news coverage often mentioned inflation and abortion as issues motivating many voters. Both of those, of course, are health care problems.
American consumers have seen health care prices rise into the stratosphere for years, while health care benefits have eroded wage increases. Health care in the U.S. is an economic kitchen table issue because it is mostly funded by the taxpayer, and therefore, like all such issues, will be on every ballot.
Abortion is, by its very nature, a medical procedure and, in many circumstances, such as ectopic pregnancy, an urgent and lifesaving one. Providing for physicians and patients to have the legal protections necessary to make clinical decisions freely will therefore also be on every ballot. But the recently completed election had at least two health reform votes openly on the ballot — one was in the U.S. Senate race in Pennsylvania and the other was a ballot measure in South Dakota.
John Fetterman, the Pennsylvania lieutenant governor who flipped that state’s open U.S. Senate seat from red to blue, overtly put health system reform on the ballot. His campaign website reads: “I believe that health care is a basic, fundamental human right, not a privilege. But health care in America is far too expensive and convoluted. In the richest nation on earth, I believe we have a moral duty to guarantee quality health care coverage for every American and end the disgusting practice of corporations profiting from people’s health and well-being.”
Fetterman proves that politicians in swing states can win while embracing comprehensive health system reform, because that is what the American voters, whether red or blue, know must happen.
Even in red states there is an underlying urge to find a way to fund health care for everyone. Prior to this year, six red states had seen the question of Medicaid expansion come to the vote through ballot initiative. In every one of those states — Idaho, Maine, Missouri, Nebraska, Oklahoma and Utah — the electorate chose to expand Medicaid even though the respective legislatures had already voted it down.
This year a seventh state, South Dakota, saw a similar ballot initiative go to the voters. And again, red state voters passed the Medicaid expansion. Together, these ballot measures will bring a total of about 900,000 low-income people onto the Medicaid rolls across the nation.
Why are these ballot measures succeeding? One analyst suggested three reasons: hearing from neighbors who will benefit, bringing federal tax dollars back to the state and protecting the solvency of rural hospitals and health clinics. Assuming that those reasons reflect the reality of health care ballot measures, I would suggest that more comprehensive reforms of the business of health care can also be accomplished with ballot initiatives.
American taxpayers have been trying to give the gift of universal health care to themselves and their neighbors for 75 years. We want our neighbors to have the care they need. We all want our fair share of federal taxation spent with purpose on improving our lives and those around us.
We see the failure of corporate medicine in rural America and we know that we can’t leave any person or any part of America behind. American voters won’t be done with health care issues until we find a way to deliver better, simpler, and therefore less expensive care to every American citizen.
Joseph Q. Jarvis, M.D., Salt Lake City, is a public health physician and author of two books about health system reform, “The Purple World: Healing the Harm in American Health Care” and “For the Hurt of My People: Original Conservatism and Better, Simpler Health Care.” He is the executive producer of a soon-to-be released documentary film: “Healing US.”