Opinion: Health, wealth, and the need to rethink California health policy

How much does a year of life cost? About $12,500 if you live in the San Francisco Bay Area. The figure may be a bit more or less in other parts of the state, but the same pattern holds. That pattern has much to tell us about the state of health care in California, and what must be done to fix it?

That figure comes from a fascinating bit of number-crunching presented by Dr. Tony Iton of the California Endowment at The Greenlining Institute’s recent Economic Summit in Los Angeles.  When you correlate life expectancy with household income, each $12,500 in annual income translates to about one more year of life, up to about $150,000 a year.
Another way to look at this is to compare census tract maps showing income and life expectancy: The tracts with the lowest income match almost exactly with the lowest life expectancy, while the highest income tracts jibe with the areas of highest longevity.

This is not just about access to health care, although that’s certainly an important factor.  It’s also about access to healthy choices: The ability to live where the air is cleaner and healthy food is readily available, having opportunities for exercise and other beneficial lifestyle choices.

And when the subject is access to care, it’s not just about being able to see a doctor. It’s about being able to see a doctor who speaks the same language, who understands your environment and culture, and is able to work with you to identify risks and deal with small problems before they become large ones.

So what do we do? First, let’s recognize the incontestable connection between health and wealth, and keep it in mind every time we approach any aspect of health policy.

Second, we must create an infrastructure in which people have access to choices that will improve their health.  That means everything from keeping at least a few of our state parks open to ensuring access to affordable and culturally and linguistically appropriate care for all.

“Even before this recession, by 2007 three out of ten Californians were relying on the safety net,” notes Assemblymember Holly Mitchell, D-South Los Angeles. “Thirty-seven percent had no healthcare insurance, 53 percent were in Medi-Cal, and 10 percent were in Healthy Families or another public program. We now have the promise of health reform at the national level, and through our budget process, state policy process, and local efforts we can build the core infrastructure that will serve every Californian and every community.”
Implementation of the federal Affordable Care Act will take us part of the way toward access to care, but by itself it’s not enough. Another obvious step is to pass AB 52, Assemblymember Mike Feuer’s bill to give state regulators the authority to reject excessive, unwarranted health insurance rate increases.

And as a state whose population is almost 60 percent people of color, we desperately need a healthcare workforce that looks like California and that speaks the multiple languages Californians speak. Right now, only 2.9 percent of California physicians identify as African American and only 3.9 percent as Latino. Given that the uninsured are disproportionately people of color, we’re looking at millions of new patients coming into the health care system who may have trouble finding culturally and linguistically competent care.

These things are not luxuries, but part of our state’s essential health infrastructure.  

“While federal health reform will provide health insurance to millions of Californians that currently lack coverage, access to care will be restricted in many parts of the state due to our current health workforce shortage,” comments Sen. Ed Hernandez, D-West Covina.  “People in communities of color already have a difficult time getting in to see a health care provider and the problem will be compounded as more Californians enter the system. We have a two-tiered health care system here in our state and unless we address this shortage the communities who need the care the most will continue to suffer.”

And all of these issues need to be front and center as our newly-created Health Insurance Exchange starts setting up the new marketplace that is intended to make coverage affordable and available under the Affordable Care Act. As the board tasked with setting up the exchange gets down to business, all of our communities will need to speak up and advocate for their own needs – and officials at all levels must listen.