The New York Times

March 18, 2010
Op-Ed Columnist

Access, Access, Access


First, a question: When in American history did life expectancy improve the most?

Was it the late 1800s, when anesthesia made surgery easier and far more common? Was it the 1930s, when antibacterial medicines became available? Or recent decades, when CAT scans and heart bypasses proliferated?

The correct answer is: none of the above. While data differ and the statistics aren’t fully reliable, a good bet is that the best answer is the 1940s. In that period, life expectancy increased about seven years.

Indeed, American life expectancy appears to have been longer in 1942, 1943, 1944 and 1945 — even as hundreds of thousands of young Americans were being killed in World War II — than it had been when America was at peace in 1940.

A prime reason is that with the war mobilization, Americans got much better access to medical care. Farmers and workers who had rarely seen doctors now found themselves with medical coverage through the military, jobs in industry or New Deal programs.

In short, great health care is often less about breakthrough technologies than it is about access. And for all the disagreements about President Obama’s health care proposal, let’s focus on this: it unquestionably would increase access, while its defeat would diminish access.

Most of American history has seen a steady increase in access to first-rate health care. But we’re now seeing a reversal of this long trend. A new report has found that one-quarter of Californians are now uninsured.

The reason for the declining access? Our politicians’ ignominious failure over the last half-century to provide universal health care, despite the efforts of Democratic and Republican presidents alike to pass it. It’s astonishing that Republicans today are lined up overwhelmingly against a health care package that is more modest and moderate than one that Richard Nixon proposed in the early ’70s.

If Republicans succeed in killing Mr. Obama’s reform package, the share of Americans with medical coverage will continue to drop. The Robert Wood Johnson Foundation estimated this month that if significant reforms do not pass, the number of uninsured Americans could grow by 10 million over just the next five years.

Partly because of lack of access, American health statistics are notorious: Our children are two-and-a-half times as likely to die before the age of 5 as children in Sweden. American women are 11 times as likely to die in pregnancy or childbirth as Irish women. The average person in Honduras or Vietnam is expected to live longer than the average African-American in New Orleans.

Opponents of health care reform claim that America’s health statistics are poor simply because of America’s racial diversity and large underclass. But there is one group of Americans who do fine in international comparisons — and that’s the 65-plus crowd. They have Medicare.

One careful study after another has shown that uninsured people are significantly more likely to die than insured people. That’s because diseases are caught at later stages on uninsured people, and they don’t get treated so well.

There’s one group that should be particularly passionate about supporting Mr. Obama’s efforts: opponents of abortions. There’s abundant cross-country evidence that the best way to hold down abortion numbers is to improve access to health care and thus prevent unwanted pregnancies.

As T.R. Reid (my editor way back in the 13th century when I was a college intern at The Washington Post) noted in The Post this week: “Increasing health-care coverage is one of the most powerful tools for reducing the number of abortions — a fact proved by years of experience in other industrialized nations.”

The United States has one-third more abortions per 1,000 women of reproductive age than Canada, and more than twice as many as Germany, said Mr. Reid, author of an excellent recent book on health care around the world. While countries with liberal social policies typically make abortion accessible and cheap, they make other elements of health care accessible and cheap as well — such as contraception and child care. Research by the Guttmacher Institute suggests that access to contraception could be the crucial factor in reducing pregnancies and abortions.

The tide of history has taken us and other Western countries toward steadily greater access to medical coverage — until recent reversals in the United States. Put aside quarrels over the mechanisms used to pass the bill, and focus on the central question of Americans’ access to decent medical care. On that issue, those trying to kill this health care reform proposal are simply on the wrong side of history.

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