Student writes an advocacy letter about health care to Senator Duckworth

The Honorable Senator Tammy Duckworth
8 South Old State Capitol Plaza
Springfield, IL 62701

Dear Senator Duckworth
My name is __________, and I have been a social worker in Sangamon county for five years now. My area of operation is family and children, a career I am passionate about because of my concern for our society.  As a social worker, I have been involved in many cases where I noticed families are having health issues, and as I see it, the astronomical health care and health insurance costs are at the root of this problem.  I know that you have a doctorate in Health/Human service; and have long and personal experience working on issues related to wounded veterans and the issues faced by persons serving in our armed services. As many of those soldiers and their families come from modest backgrounds, you are intimately familiar with the problems of health care affordability for military and veteran families when civilian non-veteran family members do not qualify for Veterans Affairs health care benefits.  

I am writing to ask you to make an improved health care system a focus issue for the Senate Democrats and your own work in government. The 2010 Patient Protection and Affordable Care Act remains an imperfect compromise, and some Republicans eagerly try to destroy it. Please join with other Democrats and reasonable Republicans (if any are to be found) to find some ways to amend the laws governing our health care system, or create new laws to improve the many deficiencies in our system.  If universal Medicare is the answer, support that.  If it isn’t, find something that is better and please advocate for that.

Please consider the possibility that economic growth and wealth is not the measure of a nation’s greatness. A good economy is something we ought to pursue, if we define a “good economy” as one in which all people find meaningful work and ways to independently meet their needs to live decent lives without deprivation. But clearly, the greatest barrier to independence and self-sufficiency lies in illness (mental and physical), injury, and disability.  And, good health and mental wellness are surely among the ultimate ends toward which economies are merely a method for achieving. Health is wealth. Health is one of the most important things in life. If Americans are sick, weak, or dead, they cannot achieve their dreams.

What then is Health? According Christian Nordqvist, in his article “Health: What Does Good Health Really Mean” (in the March 17, 2017 issue of Medical News Today) he defines health as “a state of complete emotional and physical wellbeing…” From this perspective of health, for someone to direct their own lives, shape their own destinies, fulfill their potential, or even execute a simple plan, they must enjoy psychological health as well as sustainable bodily comfort. Health should be a right for people, not a privilege deserved by those who have the money to pay for it or the type of job or military experience that brings with it decent health care.

I note that most Americans will die of heart disease, Alzheimer’s or other old-age dementias, strokes, cancer, or infections of the lungs.  Yet, what is our total federal budget allocated to universities for medical research and allocated to the National Institutes of Health or the Centers for Disease Control, the groups that do the work of preventing or curing these diseases and injuries that pose the greatest threat to us?  When I examine the federal budget, I can see that all the spending on medical research of all types must be less than $6.5 billion for the CDC and $39.2 billion for the N.I.H. (these are the bodies that make research grants to universities).  Yet, our efforts expressed in the budgets of Homeland Security, the Department of Energy’s atomic weapons programs, and the Defense Department, all to protect us from the very unlikely chance that we will be killed or conquered by terrorists or enemy nation militaries is in excess of $650 billion. That seems like a delusional misallocation of resources to me. 

But of course we do spend a tremendous amount on Medicare, Medicaid, and the Veterans Administration’s health services. But a problem here is that the health care system environment in which these efforts to provide health are embedded is horribly inefficient and leaking resources away from health promotion. For example, after some fact checking using an article in Vox written by Sarah Kliff and Soo Oh (updated May 10, 2018, https://www.vox.com/a/health-prices#chart/7), I am compelled to ask the following questions: Why is it that a patient who spends a day in the hospital in US could end up paying approximately $5,220, while a patient in Spain or Australia spends $482 and $765 for the same amount of time, treatment and other services respectively? Why would an MRI cost double what a Swiss would pay, or five times what an Australian pays?Why would the cancer drug Avastin in our country cost nine times compared with what our British counterpart pays? How can we justify the fact that a C. Section birth procedure costs $16,106 in our country, but women in Spain, Australia and Switzerland pay only $2,352, $7,901 and $9,965 respectively? A normal delivery in America could cost as high as $10,808, but Spanish, Australian and Swiss women pay only $1,950, $5,312 and $7,751 for the same delivery, and why is that? Are these countries wealthier, larger, or stuffed with more intelligent people than our country?  Kliff and Oh (2018) also point out that, “Americans use the doctors less compared to other countries, but still pay more for healthcare.”  In the same Kliff & Oh article from Vox, Tom Sackville, chief executive of International Federation of Health Plans is quoted complaining about the price of the drug Humira we buy in our country, lamenting, “It’s exactly the same product, but, in terms of the American patient, you pay double or more the price, with no health gain!”

In any bad system that causes suffering, when that system persists and resists attempts to improve it, you can be sure that some group of people benefits from the situation as it is. Who benefits from the current medical system that is so inefficient and such a burden to Americans?  I urge you to look into the answer to this question. Most Americans would agree that some people who work to promote health and care for us when we are sick or injured ought to be well-paid, and we do not mind if some people who lead the health care institutions or invent the cures and medicines and technology that can promote our well-being get rich from their work. But clearly the current system is concentrating too much wealth in the hands of too few profiteering health care and health insurance and health administration professionals, and too many (nurses, social workers, public health workers, home health care aides, nursing home workers) are working to promote health with inadequate salaries, and many more are suffering by paying too much for their medicines and medical care. 

As you and your colleagues in the Senate and House work to find an improvement on the PPACA, I urge you to look for solutions that preserve what does work well in the American health care system. Suneel Dhand lists some of the achievements of American medicine in an article “Five Things that Make U.S. Healthcare Great” (https://www.kevinmd.com/blog/2014/08/5-things-make-u-s-health-care-great.html). Many Americans receive rapid diagnosis when they feel ill or suffer injuries. We have a patient-centered care system in which many Americans are free to choose from a wide range of doctors. American patients may ask questions of their doctors, express their opinions, and complain or report doctors who mistreat them. We have a system to find and remove incompetent doctors (malpractice lawsuits), and for a variety of reasons, our health care settings are often comfortable environments where patient dignity is a priority. Our patients have good survival rates after having strokes, heart attacks, or cancer. Our university-affiliated hospitals do much of the world’s significant medical research and development. We also produce many of the new medicines and technologies.  Whatever we do to improve the American health care system should preserve these good aspects of what we have.

Sincerely yours,

Student considers policy reactions to housing affordability crisis

Democratic politicians at the state and federal level are pushing plans to dramatically expand the government’s role in addressing unaffordable housing costs, as rent prices hit new highs in major American cities and the party’s increasingly young and urban base embraces big social programs. Taken from the Washington Post. https://www.washingtonpost.com/business/2018/07/19/rents-soar-democrats-push-new-policies-affordable-housing/?utm_term=.56c9e1835168

    New policies are being suggested to regulate housing rents and control rent prices on housing units and control unaffordable housing costs. I personally think that all of this sounds good, but the reality of it is that unless they find a way to put together and standardized rent based in on the number of rooms and the location of the neighborhood.

    Currently I have the knowledge of a suggested rental price strategy named the Fair Market Rent, not everyone follows the suggested fair market rent when renting their properties because it is not enforced for the landlords to fallow the FMR.

    Now the FMR prices are mostly followed by housing programs with federal funding and affordable housing; now in an ideal situation a family should be able to pay their rent with 25% of their income. The reality is that some people actually pay about 30% of their income or more towards their housing than when they are in subsidized housing. I know about this based on my experience working with housing assistance programs in the pass, and currently working with section 8 housing assistance.

    Now the California’s Democratic nominee for governor is calling for 3.5 million housing units in the state and low-income families to receive new tax credits. In my opinion the problem with tax credits and money being given to low income families is that landlords can definitely take advantage of the fact that their tenants now have all this money for them to take by increasing their rents. This is why if there is not any type of regulations place about rent control the landlords can always take advantage of their tenants in this regard.

    I personally think that rent and fair rent should be regulated by the government in a sense that there is fair treatment about rent prices and housing conditions for those low-income families. Policies that promote fairness and stable rent prices can definitely have a positive impact in these families and their housing opportunities.

    Now in the other hand this type of policies usually don't get approved because is most likely to interfere with the wealthy landlords and the realty businesses as it is well known that some people working in the government own

 Rental properties and will probably oppose to this type of policies that will affect the interests of the rich and wealthy. 

“The reality on the ground, of how severe the crisis is, is getting the attention of the policy makers” (Diane Yentel) – President and executive of the National Low Income Housing Coalition.

    I personally think that the fact that fair regulated rent is being talked about and some good housing policies are coming out and then being rejected shows the importance of people being able to afford housing opportunities. Hopefully in the future the Housing Quality Standards for renters get to more adequate and affordable housing could definitely help to reduce the amount of people experiencing homelessness in the United States giving them the opportunity to provide for their families and get permanent employment opportunities.  

  I was not very familiar with the Fair Market Rent policies you mentioned.  I know that HUD establishes Fair Market Rent prices for various statistical metropolitan areas, and that these rates are used in setting allowed rental costs for persons receiving subsidized housing vouchers, and I also had the impression that the official Fair Market housing prices were also used in planning by community development agencies in their housing affordability strategies, but I had never considered the details of how those rates are developed or used.  Perhaps you would be interested in doing more with that issue in a later paper.

  Housing affordability and the human right to housing are indeed issues that America has not adequately addressed.  I can understand that in many markets it makes little sense for developers to produce new affordable housing, because their costs and inputs to create housing units yield far, far greater profits if they create housing for higher income residents, and even the many billions of dollars (somewhere around $7 or $8 billion?  Check the Frontline documentary)  spent by the Federal Government in tax breaks given to developers of low-income housing seem to have little impact on the problem.  The government recognizes (through policy) no right to housing (despite the Universal Declaration of Human Rights—see article 25), and almost all the $40 billion or so spent on affordable housing in this country is discretionary spending.  Also, as we target low-income households with our public housing policies, we seem to be neglecting middle-income households, who cannot afford housing in many markets (San Francisco Bay Area; Los Angeles; Seattle; Washington, DC; New York City; Boston; etc.)

   I have often wondered why government at some level (could be state or city government if not the federal government) has not become more involved in providing more affordable housing directly.  I envision governments producing dense housing areas for mixed-incomes and then selling the properties at cost (revenue neutral), and perhaps financing most of the buyers (with adjustable interest rates matching or slightly above the increases in the consumer price index, again so there is no loss or gain to the government providing the housing).    The units could be owned by the purchasers and residents, but with some sort of a land trust agreement, so that when owners sold the units outside their families (they could give the housing to spouses, children, parents, or nephews and nieces), the government or land trust would be the buyer, and a condition of the initial sale would be that the price for the unit would be the same price paid by the owner, adjusted for the inflation since the time of purchase, and perhaps further adjusted for any improvements made to the property by the owner.  

Such a scheme could: 1) make housing available; 2) have minimal long-term cost to the government; 3) provide some slight surplus (through financing the sales of units with interest rates slightly above the inflation rate for those who could afford it) to the government that could be used to provide nearly free housing to persons who could not afford it; and 4) would not damage the private for-profit housing market much, since that market is interested in maximizing profits and therefore is not serving the low-profit margin provision of affordable housing anyway.  The policy could be instituted only in areas identified as having Fair Market Housing rates that were above some fraction of typical median year-round full-time wages of workers in the area.  For example, if local two-bedroom fair market housing rates reach higher than 40% of median monthly income of year-round full-time workers, the government can set up the quasi-public land trust and housing development agency to provide the housing.  Ideally, I would like to see the mixed-income housing units constructed in such a policy to encourage more environmentally friendly housing construction and more dense housing in city centers, so that residents would be more able to walk to work, ride mass transit, and live in structures that used passive solar heating in winter and solar or wind power generation to reduce energy costs of heating and cooling.  

  One problem I don't know how to address is the problem of low-income persons who are nuisance tenants. Among the persons who cannot afford housing there is a small subset of persons who are obnoxious neighbors who would destroy property even if they owned it. The scheme I envision involves home ownership (within the context of a land trust where the quasi-public land trust entity would have the right to purchase any unit that comes on the market at a price where no profit-taking—adjusted for inflation—would be part of the property sale), partly because I think residents will take better care of their homes if they own them, but even so, there are persons who are incapable or unwilling of taking care of their housing, and while I'm sure there are policy solutions to that problem, I haven't quite figured out what they must be, aside from the idea that there ought to be some form of assisted living services available for some residents.