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,