I am not a marathon runner, but I know lots of them. Marathon runners seem to possess a unique ambition: they commit to a challenge that most of us will never take on. And they finish. They don't duck off at the 25th mile of a 26-mile course.
The United States entered into a serious public engagement with health care reform because the system was broken and it was pulling down the rest of the economy. We entered into a healthy exchange of ideas, proposals and plans to fix a series of substantial systemic, financial and even ethical issues with health care delivery. When the debate and planning began, everyone knew that the solutions would not come easily. Everyone knew that the fixes would bring into question the balance of federal state authority. Everyone knew that sacrifices would be required on all sides and that vested interests would dictate that each group would call on another group to sacrifice while holding on to their own turf with a vengeance.
We knew that achieving health care reform would be a marathon, not a sprint. Some worried we wouldn't even get the race off to a start. But as a nation, we have already made history by running 95 percent of the way. We are almost there. We cannot give up now. Not when we've come so far, not when the end is in sight.
We must stay engaged. It is time to be serious about not only finishing this marathon, but also winning it -- as a nation. So, why is a pediatrician writing this? What does it matter to children and adolescents that we achieve health care reform in 2010? As I recently wrote on The Hill's Congress Blog, we will not reach real health reform for our country without investing in a system that can provide the next generation with health services they need to grow into healthy adults.
The child health community has supported the process of health care reform for three major reasons.
1. We see firsthand the failures of our current non-system. We see families who cannot afford health care, who miss appointments, split dosages and wait too late to come in for care because they lack coverage. In this economy, these scenes are more and more common. We deal with a Medicaid payment program that values child health at just 66 percent of adult health. We see bright young people questioning whether they want to enter the medical field and take on excessively burdensome debt loads in the process. We see families struggling with out-of-pocket health care costs that pile up, especially for the families of children and youth with special health care needs.
2. There are solutions. We need only compare ourselves to other industrialized nations who spend less on health care and get better outcomes than we do. How do they do it? They have put into place the kinds of structures and programs that are now proposed in current health care reform packages. Prevention works. With the shift toward a more prevention-oriented health care system, we can save money now and in the future. In fact, recent research shows that the impact of chronic disease on our economy is a staggering $1.3 trillion a year. Yet, if we as a nation continue to make strides in our focus on prevention and treatment, we could avoid as many as 40 million cases of chronic disease and reduce the economic impact of disease by $1.1 trillion a year. By coordinating care and using quality interventions, we can cut down costly duplication of services and tests, and we can provide more comprehensive and timely care to our children and youth.
3. Our current system perpetuates inequities in society that erode our national spirit and keep us from being all we can be. As long as there are citizens who have and citizens who have not, the very essence of citizenship is questionable. The unfettered abilities of big corporations to make profits on health care need to be tempered and monitored so that all our citizens can profit. If we want to have healthy children, we need to invest in ensuring that their families and communities are also healthy. Too often, we see the consequences of families' ill health fall on their children. If we are to truly reform our health care system, we will embrace the notion that the health of everyone in the community really matters.
So, how do we finish this incredible marathon? We keep our running shoes on. Yes, we are tired. Everyone has health care reform fatigue. But we need to envision the finish line and what it will feel like to cross it. We need to redouble our efforts: focus on finding the best provisions of both the House and Senate bills that put children and families' health first, prioritize prevention, build medical homes, count the dollars and cents seriously, consider health-producing offsets and review issues of equity. And above all, we must work to make sure that pediatric patients, their families, and the quality of care they receive are the predominant concern of the health reform process--not one region, one industry or one vested interest.
Several years ago, our son John Palfrey ran the Boston Marathon. When he came across the finish line at the Prudential Center in Boston, he was cold, hypoglycemic, pale and worn out. He had worked his body as hard as a human being can work it. But he had done it. An hour later with some fluids, a warm blanket and the accolades of family and friends, he was glowing and excited.
The United States can do this. And when it happens, not only will we all stand proud together, but we will as a nation be forever changed. The beauty of passing health reform legislation is that once the race is over, once the marathon is completed, the rewards don't end with the fleeting feeling of victory -- a reformed health care system that gives our nation's children the services they need and deserve will have tangible rewards that will serve our country for years to come.