Pink Freud

(Analyzing our Collective Conscience)

I want to share with you a brief personal snapshot of the difficult realities affecting a widening circle of our local population. Last night, I took my regular turn as general pediatrician on the St. Joseph’s Hospital Medical Van in a neighborhood near Tampa, Florida. For the first time, however, I was touched to see people from a broad spectrum of social and economic circumstances using our free health care service. In a span of a few hours, I saw many familiar families still waiting for Medicaid or Kidcare health insurance (Florida’s version of the federal S-CHIP program) for their children because they were new immigrants, jobless or underemployed and forced to make agonizing choices to pay for housing, food, clothing or healthcare. I also met new families who were anticipating losing their white collar jobs and coming to us instead of their customary source of primary care, their medical home, because they were tightening their family budgets, sacrificing primary health care so that one parent could stay at home with young children or children could attend school in new clothes that fit. One young father was an architect who worked at a prestigious design firm in South Tampa and was expecting to lose his position within the next month or two. Since new construction has virtually ceased, architects (as well as contractors, interior designers, raw material manufacturers, shippers, salespeople, etc.) are thinning their ranks as well.

The downturn is clearly beginning to expand its stress way up the economic ladder. The Kaiser Family Foundation recently published a policy analysis which forecasts that for every one percent rise in unemployment, up to two million more children and adults become eligible for Medicaid and S-CHIP. Last year, 2009, Medicaid enrollment grew by almost 5.5% and Medicaid spending rose 8 %, both figures exceeding expectations and outpacing the program’s growth over the last five years.  Estimates for 2010 predict Medicaid enrollment to grow another 6.6% with spending also exceeding last year.  Most of the increasing cost of the Medicaid program is due to the increasing number of people who qualify, not from rapidly escalating costs of health care services – though surely the poorer your health, the more complicated and expensive is the health care needed to treat your problems. 

Relatedly, food stamp use is at an all-time high.  In fact, one in eight Americans now receives food stamps.  Even more ominous, one in every four children is a food stamp beneficiary.  And six million Americans, nearly one in every 50 of us, report having no other source of income – no job, no welfare, no unemployment insurance, no pensions, child support or disability pay.  That’s up 50% in the last two years alone.  Now that should make something both clear and palpable.  The financial burden of a deepening public debt is driven skyward by the consequences of job insecurity. Conversely, the health of American children is determined by their families’ access to work and its just rewards – secure shelter, healthy meals, stable incomes used to purchase clothes, books and other necessary goods, a clean and green environment and a safe, stimulating and caring community – at least as much as by their access to health care services.   As a nation of citizens, in order to protect our self-interests and promote our national health and wealth, we must invest our precious resources wisely.  Improved health outcomes and lower health care costs can only be achieved if we reform our educational and economic systems, providing knowledge and fostering skills for all children and creating sustainable jobs for every capable adult.  When government and private enterprise join forces in the public interest, then equity, in all its forms, grows.

The folks I meet in the free clinic all love and care for their children. They all have dreams for themselves and their families. They are all grateful that people act generously to support their best efforts. And, I believe, they all want us, as a civil society, to reward the value of what Freud noted to be the two essential qualities of a healthy personality – to love and to work.

                                                                                                                        Peter A. Gorski, M.D., M.P.A.
January 11, 2010

Peter A. Gorski, M.D., M.P.A. is the Director of Research and Innovation at the Children’s Board of Hillsborough County and Professor of Pediatrics, Public Health, and Psychiatry at the University of South Florida. If you'd like to e-mail Dr. Gorski directly, please click here.