Reading Neal Halfon's article on "The Primacy of Prevention" reminded me of a point that I don't make enough. Health reform, which is what we mainly talk about, is about economic security more than it's about health improvement. It's about ensuring people don't go bankrupt when they need care, and ensuring the country doesn't go bankrupt in 30 years beneath the burden of health costs. Conversely, the real gains to be made in population-health (the term researchers use for the aggregate health of the country) will come from public-health efforts. That's a broad category. It can include everything from vaccinations to stripping lead from walls to encouraging better nutrition to making educational interventions. A better integrated health system would encourage this as it would make it far easier to reach the relevant populations, but it would not, on its own, radically change the health outcomes of anyone but the uninsured or severely underinsured, and it would not necessarily be reliant on individual medical care. Rather, it'll probably require broader policy changes that make it easier for whole populations to live healthier lives almost without meaning to. That means more walkable, bikable cities. It means less pollution and lead in the walls and water. It means more access to fresh, affordable, fruits and vegetables in poor and urban areas. It means food subsidies targeted towards healthy foods rather than foods with powerful interest groups. It means more anti-smoking programs. It means, in other words, a lot of stuff that's not very dramatic and that doesn't generally have an engaged constituency behind it. With health insurance, there are a lot of folks who have lost everything, a lot of businesses that can't afford the costs, a lot of groups impacted by the economics and willing to advocate for their interests. That's a huge political advantage. These programs are important, but they're not natural political flashpoints. It's a problem.
