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Uninsured and underinsured children cost our communities. A 2007 study in Pediatrics found that communities save $2,100 for every child they insure or keep insured. Uninsured children are eight times more likely to have delayed medical care and too often end up in the emergency room where treatment can be much more expensive than in the doctor’s office. One out of every nine children in America does not have health coverage.

So write former Senators Tom Daschle and John C. Danforth, Dem and Repub, who are on the Advisory Board of the Bipartisan Policy Center.  Yes, I used the word bi-partisan.  They ae the coauthors of an op ed in todahy's Boston Globe well worth reading, with the titled The top stakeholders in health reform.  It is that op ed I will explore, although you can if you wish just read their words and skip what I offer of my own.

The expansion of the Children's Health Insurance Program, one of the more notable achievements of the current administration, especially in the light of the Bush veto of passage of an expansion in the previous administration, does not yet cover all children, as the two men rightly point out. There are still 5-6 million children not insured, and millions more who remain underinsured.

They argue for a 3 "targeted investments" that would address most remaining issues, and that would

level the health playing field and guarantee real reform that works for every child in America.

  1.  Make all children able to afford health care by raising eligibility nationally to 400% of poverty. Limit out of pocket payments for families up to 300% of poverty (66,000 for a family of four) to what medicaid would provide and ensure that benefits are not weaker than under medicaid.
  1.  This I have to put into a blockquote:  

Congress needs to make sure children’s health coverage includes all essential services. All children need immunizations, regular vision, dental, and other developmental screenings, and greater access to primary care and mental-health services.

  I will discuss this below.

  1.  Simplify enrollment in CHIP by making it automatic. Currently only 2/3 of eligible children are enrolled because of unnecessary barriers, or state-imposed barriers like prior interviews for health care.  In Medicare seniors are automatically enrolled unless they opt out, and the two former Senators argue it should be the same for children.  They also argue that the cost of health care needs to be reduced.

Let me return to the 2nd point, which caught my eye when I first read it.  Let's go through it point by point

Immunizations -  some are now mandatory for attendance at public school - I do not know if all non-public schools require immunizations, but they should.  And even home-schooled children usually interact with other children on a regular basis.  Immmunization is a basic public health precaution, children are often more vulnerable to certain diseases, and preventing disease is almost always less expensive than treatment.  Further, in many cases a sick child requires a parent to miss work without pay for the time not on the job.  

regular vision screening - a child who cannot see well will not perform her best in school.  One still needs to be able to see without strain.

regular dental screening  this might be insufficient, because it should also include access to the necessary dental treatment.  Here I again remind people that Deomonte Driver was a middleschooler in the system in which I teach.  His mother knew he had an abscess but could not afford the necessary treatment.  When the infection spread into his brain he died.  I am also aware that untreated dental karyes and periodontal problems can lead to other serious health issues.  After my volunteering at the RAM mission in Wise, I question why we still insist on treating dental separately from general health.

Regular other developmental screenings - let's start with hearing.  While there are not that many students with hearing loss when they enter school, we are beginning to see problems in middle and high school as a result of excessive use of MP3 devices played at too high a volume.  Some of the worst of the damage might be caught if tested.  And by the way -  a student who does not hear well and has that undiagnosed will often suffer in academic settings.  Perhaps like vision preferred placement in the classroom can offset some of the difficulties, but that is a barely palliative response.  Sometimes surgery could be necessary -  adenoids being cut back for example - and in some cases a device to assist hearing can be utilitized.

greater access -  I would broaden this beyond the two mentioned categories of primary-care and mental health services to include dental, for the reasons already cited.  Access is the key.  In far too many cases insurance to cover the visit is insufficient if there is no convenient way for the family to obtain treatment for the child.  The parent may have to lose a day of work for a simple office visit.  The child, having missed the school bus, then also misses a day of schooling.  I think the ideas offered should include attempting to place basic medical clinics, including mental health screening and possibly basic dental including hygienists for cleaning, at school sites, where the children could receive treatment without missing school and without the parents having to be present and thereby losing income.

There are good thoughts in this op ed.  One wonders where we might be on health care were Daschle leading the effort on behalf of the administration and were men like John Danforth still in the Senate instead of Missouri's current obstructionist senator Kit Bond.  Here I note that Danforth was replaced originally by John Ashcroft, and that replacement indicates how much the possibility of bipartisanship has disappeared since he and men like him left the Senate.

The two men close by noting that in the coming days Republicans and Democrats will have to decide how they will respond to the opportunity to level the medical playing field for children:

We’re willing to bet that each of them has stood up at a fund-raiser or a rally and uttered the words "Our children are our future.’’

It’s true, economically and morally. Now it’s time to make sure that future is a healthy one.

economically and morally  we should remind those who resist this kind of meaningful change of both adverbs.  It is far more economic to prevent illness or treat it in its early stages than to have people resorting to emergency rooms or perhaps dying from untreated but treatable medical and dental issues.  And to suggest that the poverty of a child's parents should in any way make that child less worthy is an absolute denial of the equal opportunity that should be the bedrock not only of our approach to medical issues, but all issues affecting their future.  Anyone who tries to argue for something in opposition should be challenged with the hard truth that what they are doing is speaking and acting immorally.

I hope my sharing the op ed is of value.  And that the words I offer add something.

I read, I felt obligated to share as widely as possible.

Do with this diary what you will.  That is not important.

What is important is to act, speak, advocate, demand that we ensure that all of our children immediately get meaningful access to the medical care necessary for them to lead productive lives.


Originally posted to teacherken on Mon Sep 07, 2009 at 05:22 AM PDT.

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