Obama depending on us to lead healthier lives in ’09

Published 12:00 am Sunday, December 28, 2008

America’s next president wishes you a healthy new year.

Indeed, a cornerstone of Barack Obama’s package of changes is that Americans will work to be healthier than we are now, mostly through eating right, exercising and getting regular checkups.

We don’t do that now, especially in Mississippi. We have the incredibly weird distinction of being the state where the people are both the poorest and the fattest. We’re way up on lists of hypertension, smoking, diabetes …. on and on.

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Many if not most of our ills could be avoided if we’d not only resolve to take better care of ourselves, but actually do it.

Before winning the Democratic nomination, Obama was repeatedly faulted by Sen. Hillary Clinton for scripting health reforms that were less comprehensive than hers. Obama does not advocate a government-run medical industry. Obama terms such an approach extreme. He advocates add-ons for the existing system “that provide affordable, accessible health-care options for all, make insurance companies accountable, and ensure patient choice of doctor and care without government interference.”

But because Obama doesn’t favor a single, cradle-to-grave system, America’s way of doing things will be even more complex than it is today.

Under the Obama plan if adopted by Congress:

• Medicare, the federal program for those 65 and older, will not change except that negotiating for cheaper prices on prescription drugs will be allowed.

• Medicaid, the federal-state program that along with the Children’s Health Insurance Program provides services to the indigent and working poor and disabled, will not change other than through an expansion of eligibility.

• People who have health plans through their employers may continue just as they are. The government will decide which employers should provide coverage and those who don’t will be assessed.

• People who don’t have health plans through their employers will get tax credits to buy insurance.

Numbers from Washington — and especially from campaigns — are far from dependable, but the shift to Obamacare is calculated to add a net of $60 billion to $100 billion a year to the federal budget.

No problem, Obama says. By increasing taxes on Americans earning more than $250,000 per year and retaining the estate tax at its 2009 level, there will be enough new revenue to break even.

“I believe that it is entirely realistic that Congress will work to fully fund this plan because the economic costs of continuing to let our health-care costs spiral out of control are simply too high for American families and American businesses,” is how Obama put it.

Of course, there are other tweaks in the Obama plan, such as allowing young people up to age 25 to continue coverage in their parents’ plans, fully “portable” coverage, savings through reducing paperwork and such. Far too many wrinkles to mention here.

But a key tenet he stressed time and again is that both the costs and demand for health-care services will decline once we modify our behavior. And he firmly believes we will, once we can visit a doctor’s office regularly to receive advice and counseling without bankrupting ourselves.

Sadly, the facts in Mississippi argue otherwise. Here, one in five adults and about half of all children are enrolled in Medicaid or CHIP. While a few at the upper-income limits in these programs face $10 copays, their care — across the board — is paid for with public funds. Yet there’s no showing that people with “free” health care pay better attention to their diet and exercise or have better health overall. Indeed, the opposite might be true.

It’s possible that’s too broad an observation. Even for those with “free” care in this state, finding a doctor isn’t always a cakewalk. Another category in which we’re 50th is physicians per-capita. In Mississippi, there are 1.8 private physicians for every 1,000 residents compared to 4.5 per 1,000 in Massachusetts. And most doctors the state does have practice in the Jackson area, not in the rural parts of the state. Some counties have no doctors at all.

Clinton, of course, would have changed that. Under her plan, it was expected that doctors might be assigned places to work as a condition of their licensure.

She lost, though. And so it is Obama’s far less sweeping package that will be presented for the House and Senate to deliberate.

He is correct, by the way. Any physician will tell you that while some diseases are indiscriminate, we have the power to control risk factors for lots of the ailments that land us in hospital beds. Soon and officially, the president of the United States will expect us to do better.

The least we can do is try to oblige.


Charlie Mitchell is executive editor of The Vicksburg Post. Write to him at Box 821668, Vicksburg, MS 39182, or e-mail cmitchell@vicksburgpost.com.