The presidential election is neck and neck, and although the electoral math stacks in President Obama’s favor, the race is far from over. While throughout the campaign, we’ve heard a lot about health care—how access to clinical services in the advent of ill health should be allocated — we’ve heard substantially less about public health, a much broader, more multifaceted issue.
The Institute of Medicine (IOM) defines public health as “what we, as a society, do collectively to ensure the conditions for people to be healthy.” Under this conception, public health is more about promoting health, rather than reacting to disease. While health care is an important part of that, public health is much bigger, and includes tending to the safety of the air we breathe, the water we drink, the food we eat, the drugs we rely on, the parks and playgrounds where we commune, the infrastructure we take for granted, the vaccination and disease prevention programs that we don’t even know are protecting us, and — importantly, given the recent events on the East Coast — the preparedness and relief programs that are there for us should disaster strike.
Despite difficult economic times and petty partisanship, President Obama has done well by public health. Passing the first (relatively) comprehensive health care reform act in American history doesn’t hurt his cause. But earmarking what was originally $21 billion in federal funding over 12 years to a “Prevention and Public Health Fund,” supporting his First Lady’s “Let’s Move” Campaign to reduce childhood obesity, and including health research funding as a main piece of his Recovery and Reinvestment Act push him over the top.
Now, let’s have a look at public health under a Romney presidency.
One thing should be clear right away: Public health is what we do collectively to ensure conditions for people to be healthy. “Collective,” the operative word, isn’t exactly Romney’s favorite. Although a relative moderate in an increasingly rightward-moving Republican party, Romney has been clear about his opinion regarding public goods and services.
From Big Bird to Medicare, a Romney presidency threatens many of our country’s most sacred public institutions — many of them with severe health implications. Let’s move through the life cycle, considering Romney’s positions on health-relevant public institutions at each stage.
First stop: Planned Parenthood. Romney has been clear that as a pro-life candidate, he would defund Planned Parenthood. What the Governor may not appreciate is that Planned Parenthood is an important avenue by which millions of people in the U.S. attain access to contraception — the kind of contraception that prevents unwanted pregnancies, and by implication, abortions. The danger here is that defunding Planned Parenthood would leave millions of women without ready access to contraception, increasing the number of unwanted children — creating serious challenges for those children and their parents alike.
But not only would many women lose access to the contraception that Planned Parenthood would have afforded them — when they do get pregnant, they’ll find themselves with fewer resources to care for themselves and their young children. The Women, Infants, and Children (WIC) program, which provides prenatal care and supplemental nutrition for pregnant women and their children under the age of 5, is already facing serious budget cuts. Given vice-presidential candidate Paul Ryan’s support for cutting funding for government programs, like WIC, in his role as Chair of the Congressional Budget committee, support for this program on which nearly 10 million Americans rely isn’t likely to improve, if it isn’t chopped altogether.
Finding good, affordable health insurance for these children will be more difficult, too. The Children’s Health Insurance Program (CHIP) passed in 1997 is a federal program that helps insure low-income children whose families aren’t eligible for Medicaid, but who cannot afford private health insurance. The program plugged an important hole in providing health care for low-income children. Under the Affordable Care Act (ACA), CHIP was extended — Paul Ryan, however, made shrinking CHIP a focal point of his long-term budget plant.
When it comes to health care more generally, a Romney presidency would spell disaster. Despite championing a nearly identical healthcare plan in Massachusetts while governor, Romney has kowtowed to Republican pressures to oppose the ACA — stating many times that repealing the ACA would be one of his first actions upon taking office.
Repealing the ACA would be a catastrophe. The ACA has not yet taken effect, so today, 17% of Americans are uninsured — that compares to just 4% in Massachusetts, where state health reform similar to the ACA was enacted (led by Romney himself, mind you). Simple math suggests that repealing the ACA would leave 13% of Americans out in the dust over the long term. Never mind many other benefits of the legislation: barring insurers from excluding beneficiaries based on pre-existing conditions, guaranteeing coverage for young people on their parents’ health plans through 25 years, mandating that health insurers guarantee access to contraceptives for beneficiaries, and funding programs, like affordable care organizations, that cut long-term Medicare costs without cutting services.
On the topic of Medicare: More disastrous still is Paul Ryan’s plan for the program, which would essentially gut the program we know today, replacing it with a subsidized private health insurance program for the elderly. Ryan’s plan puts no limit on the potential out-of-pocket costs seniors could incur, nor does it address prescription drug coverage. That elderly Americans — who have spent decades contributing to the American project — could be forced to squander away their savings on health care is unthinkable. It’s the very situation Medicare was created to avert in the first place.
And beyond the institutions that support public health throughout Americans’ lives, a Romney presidency would have other damning consequences for America’s outlook on public health
Let’s start big — like Earth big. The devastation wrought on New York City by Hurricane Sandy prompted New York’s Mayor Bloomberg to endorse Obama for president, citing the importance of climate change issues, which scientists have argued are responsible for the increasing frequency of large natural disasters like Sandy. It’s clear that Romney doesn’t see climate change as part of his presidential responsibility. In his speech to the Republican National Convention, Romney scoffed at Obama’s embrace of climate change, saying, “President Obama promised to begin to slow the rise of the oceans and to heal the planet. My promise is to help you and your family.” Given the potential for our changing climate to wreak Sandy-like havoc around the country, Romney’s climate skepticism is certainly a challenge for public health.
And then there’s Romney’s dubious position on inequality. Famously, in a closed fundraiser speech to plutocrat supporters, Romney railed on the 47% of Americans “who are dependent upon government, who believe that they are victims, who believe the government has a responsibility to care for them, who believe that they are entitled to health care, to food, to housing, to you-name-it.” The statement codifies Romney’s belief in a fundamentally unequal society — which there are, by implication, 53% of Americans who are rich enough not to rely on government handouts. They are the good people, working hard for their rewards. And then there are 47% of Americans who are slovenly moochers reliant on government handouts to underwrite their laziness.
This belief has serious implications for public health. Never mind the fact that it blames the poor for their poverty, but it justifies dismantling social services that, in Romney’s narrative, allow them to leach off of the 53% of hard working (read rich) Americans. What’s worse, well-supported research suggests that inequality — independent of income — is an important driver of poor health. Although our society is already trending toward increasing inequality, and has been over the past several decades, this will surely accelerate under a President Romney, where resulting inequality is justified, even celebrated, as the byproduct of the innate work ethic and general goodness of the rich.
What makes a Romney presidency all the more dooming for public health is that he would likely take office with Republican majorities in both houses. And while President Obama tried to make overtures to bipartisanship during his first two years with a Democratic supermajority, it is unclear that Romney would do the same. That means that cuts to crucial public health programs, outlined above, would be swift and uncompromising.
Public health is about collective action for mutual benefit — and it’s clear that Romney supports neither collective action nor mutual benefit. Given his support for dismantling America’s public health safety net, his skepticism about climate change, and his embrace of social inequality, a Romney presidency would make for four painful years for public health, and by extension, Americans. And the reverberations of those four years would certainly last much longer.
This article originally appeared on the 2x2 Project: Health Beyond the Headlines.