Kentucky Government, Politics, and Public Policy

18. National Health-Care reform and Health in Kentucky

325 18 National Health-Care Reform and Health in Kentucky Ann Beck In 1993 Democratic governor Brereton Jones proposed “quality, affordable health care for every Kentuckian.”1 In the early 1990s the Kentucky public overwhelmingly supported such action; about 90 percent of randomly polled Kentuckians believed that health care was a fundamental right, 70 percent were willing to pay higher taxes for universal coverage, and 75 percent favored a payroll tax on companies that did not provide health insurance to employees. The legislation proposed by Governor Jones (but never passed by the state legislature) was remarkably similar to the national health-care reform legislation passed in March 2010. Like the current Patient Protection and Affordable Care Act passed in 2010, the proposed 1993 legislation • used existing private (profit-based) insurance practices to cover citizens; • managed competition among health-care providers and insurance companies to control costs; • required universal health-insurance coverage (all residents were required to have insurance) for Kentuckians to assure access to various medical-care services; • established set basic benefits for all health-insurance policies to promote basic equity in services available to both rich and poor; • placed conditions on insurers to use community rating systems that would even out the price that each individual paid and reduce price differences for the old and chronically ill; • regulated medical charges (discounts from providers for belonging to an insurance network with many potential patients) to hold down the spiraling cost of care and managed care for Medicaid recipients; and • required larger employers to provide basic medical-insurance coverage for employees or pay a tax to assure employees continued access to medical-insurance benefits through the employer.2 326 Politics and Public Policy Issues Similar to the intent in 2010, the practices proposed in 1993 were primarily designed to assist residents in getting medical services that would help them (1) access reasonable treatment for chronic (long-term) or acute (immediate) injuries or illnesses; (2) avoid individual financial ruin through sharing the risk and costs of providing treatment ; and (3) prevent or delay the onset of various chronic or acute illnesses through preventive care, such as immunizations, screening tests, use of pharmaceutical treatments , and periodic evaluations of possible health risks by a health-care professional. The legislative and public debate over both the proposed 1993 legislation and the 2010 passed legislation has tended to center almost exclusively on the idea that a medical-care system is the same as a health-care system. A medical-care system focuses on who can get access to medical treatment, how the cost of this treatment can be provided for through existing insurance structures and who will pay for this treatment , and how the costs of medical services might be held in check and quality might be maintained. The medical-care model focuses on problems of each individual in isolation and reflects only one of a variety of models that can be used to protect and promote the health of people. The individualized medical-care model gives very little attention to how health is connected to persons’ larger physical, social, political, and cultural environment. The medical-care model of health seeks to treat most “illnesses” or health concerns through the use of technical interventions and prescribed pharmaceuticals controlled by an elite set of practitioners. But is this individualized medical model the best model for promoting the health of Kentuckians? In this chapter I explore what is meant by “health,” why governments have always been involved in “health” issues in the United States, how the current model of medicalized treatment came to dominate the way we think about health and health care, how Kentuckians currently fare on many measures of health, and what the impacts of the national “health-care” legislation might be on both the medical-care system in Kentucky and the wider conception of health care for the people of Kentucky. Defining Health and Government Involvement in Health Care People rate good health as one of the most important aspects of having a good life and a valuable individual and collective goal. What matters most is not only the length of one’s life but also the quality of that life. The World Health Organization defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.3 The extent of this sense of physical, mental, and social well-being (a dynamic state of health) experienced by a person is a product of individual genetic...