Capitol Correspondence - 12.17.19

Think Piece: Balancing Social vs. Medical Services

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This HealthAffairs blog post about how state funding can strike a balance between social and medical spending provides food for thought as social determinants of health receive greater attention. As always, ANCOR’s sharing of this post does not necessarily serve as an endorsement of its content.

As written by HealthAffairs:

“But the largest challenge to shifting spending toward social services may lie with persuading the American public that we are making an implicit tradeoff between exorbitantly priced health care and the nation’s health. In prioritizing medical care over social services, education, and the other community conditions that determine health, policy makers and legislators have been doing what people want, which is to ensure insurance coverage. Most Americans still see access to health care as the key to a long and healthy life—despite the fact that life expectancy in the US continues to drop in the face of improvements in access since the Affordable Care Act.

They know that there are many factors that can put their health at risk, such as stress, smoking, and lack of exercise, but that has not translated into a demand for a systematic effort to address the multiple community conditions that affect everyone’s health. According to a survey released in 2018, a majority of respondents see health care coverage as the government’s responsibility, but they see health as a personal responsibility. This view further erodes support for government programs that address social factors and improve community conditions. Even the community factors that have helped drive the epidemic of addiction, mental health issues, and “deaths of despair” may be viewed by most Americans as problems that cannot be addressed by government.

If we want lawmakers to make different decisions about how to allocate tax dollars, voters will need to understand that medical care is responsible for only a fraction of the health and well-being of their communities. They need to see that allowing health care costs to continue to rise faster than the rest of the economy not only affects their pocketbooks but also their overall health.

Our California project was the first in what Well Being Trust and the Lown Institute hope will be a series of similar studies of individual state budgets. Just as all politics is local, so is information about spending on medical and social services. Residents of each state deserve to understand where their tax dollars are going, and whether the state’s budget represents the best use of funds for improving their health and that of their neighbors.”