Editor's Note
We All Need a Net
On January 12, 2010, the country of Haiti cracked apart. Within minutes, its already torn and tattered social fabric was ripped by a magnitude 7.0 earthquake, and, suddenly, there was no safety net. All the services that supported the Haitian people in their tenuous existence stopped, tens of thousands died, and the living were left with chaos. Every society has some sort of safety net, intended to catch the less-fortunate, and few will ever experience the destruction that Haiti has, but Haiti’s plight dramatizes how life-sustaining to all, not just the poor, are the systems that support a nation.
Although paltry in comparison with those that rocked Haiti, tremors are threatening the social safety net in the United States, and perhaps nowhere is this more striking than in health care. Shaken by a struggling economy and demanding demographics, the medical bulwark of the elderly, Medicare, marches toward certain insolvency and will reach that point unless the financial numbers change. Strapped by mounting deficits, states have ratcheted down their Medicaid programs to cope with red ink. And in Minnesota, General Assistance Medical Care (GAMC), which provides health insurance to the poorest of the poor, sustained a seismic hit when Gov. Tim Pawlenty first line-item vetoed funding for 2011 and then “unallotted” money for 2010, a move that will essentially eliminate the program.
The budget crunch has frontline health care providers scrambling to make do. Community clinics are getting inventive in their use of resources (p. 22) and safety-net hospitals such as Hennepin County Medical Center and Regions are creatively lobbying politicians even as they trim already spare budgets (p. 10). As money gets tighter, somehow those least able to withstand it get squeezed the most.
Health care reform could potentially ease the squeeze. Many of the provisions of the U.S. Senate’s reform bill could patch the safety net, catching thousands who would otherwise languish in the shoals of the uninsured. Yet the bill currently sits embroiled in a House/Senate conference committee debate. The recent Republican victory in the Massachusetts senatorial election to replace Ted Kennedy likely dooms any quick resolution. Federal reform will not soon save the health care safety net.
Some would say that tough times demand tough choices, and some programs have to suffer. But I wonder what is lost when a society leaves its most vulnerable even more vulnerable.
As I write, my wife and I have just wished Godspeed to our youngest son as he left for Haiti with a contingent from the Naval Postgraduate School that will erect temporary towers, string cable, and scavenge electricity from wind, sun, and battery to provide a communications network that will link relief efforts attempting to rebuild the Haitian safety net. After the dead are buried and the injured mended, Haiti will need that net. A medical and social safety net is a measure of a nation’s humanity. No country should be without one.
Charles R. Meyer, M.D., editor in chief Dr. Meyer can be reached at cmeyer1@fairview.org