Healthcare Reform: A Health Promoter's Perspective

Carrie Rheingans

As a health promoter, I often think about how to prevent disease from even happening. One characterization I heard about the U.S. healthcare system was from former U.S. Surgeon General Dr. Joycelyn Elders at last year’s Public Health Practice Symposium was that the U.S. doesn’t even have a ‘health’-care system – we have a ‘sick’-care system. I think that is really true – we as a country fund treatment a lot more than prevention activities. I see this same priority in in the field of HIV too. It’s relatively easy to prove that you’ve served the health needs of people living with HIV compared to how much HIV you prevented from happening (measuring what didn’t happen gets tricky, right epid people?!)!

Healthcare reform made me remember something that was said at orientation in fall 2008 when Health Behavior & Health Education (HBHE) Chair Marc Zimmerman was introducing us to the U-M SPH. He gave a general overview of each of the five U-M SPH departments and how they work together. When he got to the Health Management and Policy (HMP) department, he said that we in HBHE really work closely with them. At first, I found this absurd, because I had the impression that HMP was all about making money in the healthcare business and HBHE was all touchy-feely and focused on really working with individuals to cater to their health behavior change needs (neither is entirely true; they are both much, MUCH more than that). His point was that the research that comes out of HBHE can inform the policies that are made – incentives and disincentives (=fees) for example.

All that being said, I really appreciate that this new bill adds more of a focus on prevention and funding prevention research and programs. I have a suspicion that the strength of two large businesses – health insurance and drug companies – has had an effect on the over-focusing on treatment and under-focusing on prevention. Politicians are the ones who make these laws, and they want to keep their jobs, so they vote and make laws in the interests of those who fund their campaigns (which sometimes are their constituents, but are often large, profitable companies). Don’t get me wrong; I’m not a business-hater. We obviously need health insurance and medications with this new bill.

As someone in public health, it’s difficult to argue that over 30 million more people having health insurance is a bad thing… and with the new funding of prevention activities, there may even be job security in my future! Dean Kenneth Warner sent a reflection email to all SPH students, faculty and staff the day after the bill passed claiming “This is an occasion for public health celebration”. On Tuesday in my intro to the U.S. healthcare system class I’m taking this semester with Dr. Richard Lichtenstein in HMP, he was happy that the bill finally passed, though he jokingly lamented having to change all his lecture slides for future semesters. I think that’s a small price to pay for a better quality of life for millions of people living in this country

Here are some thoughts from many faculty in SPH about healthcare reform

Here’s a video of Dr. Lichtenstein discussing healthcare in the U.S. (this video is a very quick synopsis of the class I’m taking with him this semester)

U-M’s University-wide collection of voices from within the University on the healthcare debate

Tags: HBHE, health care reform, HMP, insurance, policy, prevention