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Public Health: Grounded in Values. Americans believe in the common good and equal and unbounded opportunity for all. Access to affordable, quality health care is therefore a crucial policy priority and moral challenge. By ensuring that the benefits of modern medicine are available to all, we can prevent people from dying prematurely, delaying needed care, and being forced to choose between basic necessities like rent and health care. Covering all Americans would also protect individuals from the economic hardships that can result from illness, lead to substantial gains in productivity and improve our businesses' competitiveness. But beyond these health and economic gains, for most people, ensuring access to affordable, quality health care is a simple matter of right and wrong. Most value systems, including major faiths, ethical perspectives, and human rights doctrines, offer moral support for fair and just access to health care. The belief that every person deserves quality health care is embedded in our core values, and our vision of health care over the next generation must honor that conviction.
Record of Neglect. Unfortunately, we are falling short in meeting our national and global commitments on health care. In America and throughout the world, people in need are increasingly unable to access affordable, quality health care. Since 2000, the number of uninsured rose by 5 million, to 45 million, or about one in six Americans. Americans are also struggling with skyrocketing health costs. In 2004, the cost of employer-based health benefits increased at a rate five times higher than that of wages; since 2000, the family share of such coverage increased by over 60 percent. These twin pressures of less coverage and rising costs are squeezing families and forcing Americans to go without care. Compared to people in Australia, Canada, New Zealand, and the United Kingdom, Americans report higher out-of-pocket spending and are most likely to say they did not see a doctor when sick, did not get recommended tests or follow-up care, or went without prescription medicines because of cost in the past year. At the same time – and not unrelated – America continues to have worse than expected health according to a number of health care indicators. The U.S. has lower life expectancy than 20 other nations, near-epidemics of preventable conditions, and its infant mortality rate actually rose in 2002 for the first time in 40 years.
The United States also shares in the global struggle against epidemics such as AIDS, tuberculosis, and malaria that are wiping away entire portions of the populations of developing countries. In addition to the devastating toll of HIV/AIDS, nearly 2 million people die of tuberculosis each year, despite the availability of effective and inexpensive treatments. Malaria causes at least one million deaths per year and an additional 300 to 500 million clinical cases, the majority of which occur in the world's poorest countries.
Matter of Priorities. American policies can make a difference in overcoming these national and global health challenges. Our nation, the most prosperous and powerful nation in the world, has the means to ensure that none of our neighbors is unjustly denied life-saving treatments due to their income, their race, or any other reason. We have the capacity to invest in public health efforts that can prevent illness and prolong lives. We have the ability to secure a safe, effective, and affordable medicinal arsenal. With resolute leadership and realigned priorities, our nation can readily meet all of these goals.
However, rather than embracing these challenges, in recent years political decisions have moved our country farther from achieving our health care goals. The past couple of years have brought an unprecedented reversal in the nation's fiscal health, moving from record surpluses in 2001 to a $413 billion deficit in 2004. This reversal is largely the result of President Bush's tax changes, the benefits of which overwhelmingly flowed to Americans earning the highest incomes – 73 percent of the cuts went to the top 20 percent of income earners. Rather than spending money to fix the health care crisis in this country, or the myriad of other social problems, President Bush and Congress chose to enact tax cuts for the wealthy. Now, to fill the hole created by the tax cuts, President Bush proposes to limit spending on programs such as Social Security, Medicare, and Medicaid – programs that disproportionately benefit poor, disabled, and elderly Americans. Such spending limits represent a significant retreat from the commitments our nation has already made to some of the most vulnerable among us. Additional proposed tax changes that would benefit the relatively wealthy among us would further prevent any progress from being made on the important national and global health challenges we confront.
Potential Problems in the Forthcoming Budget. Since the federal budget is the most tangible embodiment of our nation's priorities and values, it should express our commitment to ensuring fair and just access to affordable, quality health care for all. At a minimum, it should do no harm. Listed below are examples of potential budget policies that may indicate a retreat from the values at the core of our country and could exacerbate health threats that Americans and people around the world face.
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