It was nice while it lasted, but the brief surge in optimism surrounding debt-reduction negotiations died Sunday, when Speaker of the House John Boehner announced that his party wouldn’t swallow President Obama’s proposed $800 billion tax increase as part of a package designed to save $4 trillion.
If nothing else, the collapse of the negotiations made it clear that Republicans don’t care about the deficit per se. What they care about is cutting federal spending and taxes, and they’ll do that even if it means partially dismantling popular entitlement programs in the process.
One would think the GOP would have gotten the message that this was a bad idea when a reliably Republican district in upstate New York elected Democrat Kathy Hochul to fill a vacant House seat in a special election last month. Hochul’s entire campaign revolved around preserving Medicare and denouncing a plan by Republican Paul Ryan to transform it into a voucher program, cutting benefits in the process.
In fact the draconian spending cuts envisioned by GOP deficit hawks would impact the health of American citizens far more profoundly than the Ryan plan envisions.
That’s because, as I argued here and here, public health isn’t a medical problem at all. It is a socioeconomic one, and cuts to many programs other than those proposed for our health entitlement programs will affect national well-being and health as a result.
Take Canada for example. That country provides universal, free access to health services for all citizens. If poor access to health care (a problem that would be exacerbated by GOP cuts to health entitlement programs) was the only factor driving poor health outcomes, then we shouldn’t see poor, or less educated people experiencing poor outcomes in Canada. But these differences do exist, in spades. In a recent study of 15,000 Canadian adults for example, participants in the lowest income group were nearly 3 times more likely to die of any cause than those in the highest income group. They were also more likely to have diabetes, high blood pressure, cancer, cataracts and many other conditions. The study revealed similar disparities when participants were stratified by educational level.
In a recent editorial for the Journal of the American Medical Association, Steven Woolf of Virginia Commonwealth University describes how spending cuts for non-health related programs, particularly education, can affect the health of Americans as well. In 2007 for example, Woolf reports that adults who graduated a 4-year college were 4 times less likely than those who had not graduated high school to report their health as ‘fair’ or ‘poor.’ The latter group had more than twice the prevalence of diabetes, a risk of stroke that was 80% higher, and a life expectancy that was 5 years shorter than that for college graduates.
Many factors underlie the link between health disparities and educational status. Educational achievement is indirectly correlated to obesity and cigarette smoking, for example. It is also linked to jobs with better benefits (such as health insurance).
Income levels are also correlated with poor health. Poorer folks tend to skip exercise, eat unhealthy meals and forego medications in order to save money for other necessities. They must contend with pollution, pest infestations and crime (which increases stress and depression).
GOP deficit negotiators must remember that short-term plans in the name of fiscal discipline can create far larger budget problems in the long run, to the extent that they undermine the health and wellness of tens of millions of Americans. Health-related entitlement programs already consume 23% of the federal budget. Some of the cuts proposed by GOP budget hawks will cost people their jobs, cut their income and interfere with their right to pursue a good education. These cuts will increase the burden of illness for millions of people, possibly for generations. That will drive-up health spending and yes, raise the deficit to unimaginable levels before too long.
Many voters can’t see past the issue of short-term deficit reduction, but we elect officials to lead, especially when times are tough like they are now. For sure, it is hard for elected officials to make decisions that are in our nation’s long-term best interests, since they must please their constituencies in time for the next election cycle. Then again, that’s what leadership is all about.