Of Health Care, War, Costs and Consequences

In the next few weeks this country will make two decisions of great consequence: Will we send additional troops to Afghanistan? Will we reform our health care system?

It is both instructive and disheartening to see the different ways our policymakers approach these issues.

When it comes to health care, the emphasis is on costs. When President Obama introduced his health care reform initiative, he justified it as a way to lower health care costs and help the economy. Later he pledged to a joint session of Congress, "I will not sign a plan that adds one dime to our deficits -- either now or in the future. Period."

A few days ago the Congressional Budget Office (CBO) gave health reform a green light when it concluded that the Senate bill wouldn't add to the deficit. The $800 billion additional cost would be offset, in large part by cutting spending in another part of the health care sector -- Medicare.

When it comes to the Iraq and Afghanistan wars, on the other hand, talk of costs and deficits disappears. When Obama sent an additional 21,000 to Afghanistan earlier this year, neither party discussed the cost. A few days ago the Senate voted 93-7 to fund those additional troops, bringing to $1 trillion the amount we've spent in Iraq and Afghanistan. No member of either party talked about costs. The CBO was not asked to analyze the impact on the deficit of sending additional troops. And unlike with health care reform, the Pentagon was not required to offset the increased costs of the Afghanistan war by cutting spending in other parts of the military budget.

Why do we approach these two crucial issues so differently? Some would say the answer is obvious: War is a matter of national security. It certainly is. We need to defend ourselves against our enemies. But if protecting American lives is the objective, the absence of health care undermines our national security far more than terrorism.

In the 9/11 terrorist attacks, 2,800 died. According to a study recently published by the American Journal of Public Health, that is the number of Americans who die every three weeks because of lack of access to health care. Since we intervened in Iraq, about 300,000 Americans have died from lack of health care, about the number of American soldiers killed in World War II.

Indeed, the national insecurity resulting from our actual lack of health care is far greater than the number who die from it. Tens of millions of Americans worry about losing their health insurance, or having their insurance company deny their medical claims. Medical expenses significantly contribute to about 50 percent of personal bankruptcies. In about 30 percent they are the primary factor.

We will never achieve real, effective and universal health care until we treat the lack of it as a national security issue. Perhaps we could start by adopting some of the language used to justify war. If Obama chooses to maintain or reduce current troop levels, his opponents will undoubtedly criticize him for adopting a policy of "cut and run."

Consider that the Senate health care bill will still leave 25 million uninsured. By one estimate, that translates into 25,000 avoidable deaths annually. Why then aren't we saying that when it comes to saving American lives, the Senate has adopted a policy of "cut and run"?

Health care is a national security issue. Our policymakers need to approach it that way.