Population Health Blog

Population Health Blog

Why It Matters

Michigan court case on the ‘right’ to literacy offers insight into the right to health care

By Dennis Archambault
People who believe health care is a right, might want to pay attention to a recent court case that concluded that education isn’t a right (https://www.freep.com/story/news/local/michigan/detroit/2018/06/29/judge-dismisses-lawsuit-against-snyder-over-detroit-kids-literacy/747732002/). There certainly is legal reasoning behind the pros and cons of this argument, but with the conservative bent of the judicial system these days, it’s safe to assume that the definition of “rights” guaranteed by the constitution is fairly narrow and not really open for debate.
What’s interesting in Judge Stephen Murphy’s response is that he acknowledged the deplorable condition of education for students in low income communities like Detroit. “The conditions and outcomes of plaintiffs’ schools, as alleged, are nothing short of devastating. When a child who could be taught to read goes untaught, the child suffers a lasting injury – and so does society.” But that’s not a matter for the courts. “In other words, access to literacy is not a fundamental right,” Judge Murphy wrote. It’s a matter for elected officials, judged in the court of public opinion and eventually in elections.

An affluent society that believes in social equity should provide a basic standard of living that guarantees opportunity for the vulnerable, but it is not bound to do so. Education, health care and disease prevention services, housing, food security, safety, mobility – these are social values that need to advocated for, and once won, defended as public opinion and elected leadership changes. These are social determinants of health and wellness, which judges like Stephen Murphy would say are important to society, but not guaranteed by the constitution.

The takeaway from this decision? The political process matters. As crazy as it seems at times, it is the process through which a democracy thrives, and how society advances, or not.

Dennis Archambault is vice president for Public Affairs, at Authority Health.

Well-financed advocacy groups resist upstream change, frustrating health equity efforts

By Dennis Archambault

Special interests have always financed advocacy efforts. But the recent article, “How the Koch Brothers Are Killing Public Transit Projects around the County” (https://www.nytimes.com/2018/06/19/climate/koch-brothers-public-transit.html) offers a perspective on how difficult it is to make “upstream” systemic change to influence the social determinants of health.

Publicity about workers spending hours on bus rides to work – or walking in all kinds of weather — have raised awareness as to how difficult it is to get to (and hold) a job in this region. But the sobering reality is that there are oppressive financial forces, such as Americans for Prosperity, that provide financing to oppose progressive, social programs like regional transportation. Americans for Prosperity is the advocacy group funded by the Koch brothers, known for financing countless Republican campaigns. Paid activists, using a sophisticated data service, identify voters inclined to be of a more conservative orientation, then appeal to their interests.

Recently, civic leadership in Nashville supported a $5.4 billion transit plan. Americans for Prosperity made 42,000 phone calls and knocked on 6,000 doors to engineer defeat of the measure. “This is why grassroots works,” said the Tennessee state director for the organization. Their mantra: Public transit goes against what some Americans define as “liberties.” If someone has the freedom to go where they want, do what they want, they’re not going to choose public transit. They’re probably not going to be inclined to support other measures that remove social determinants of health – because the fear of governmental encroachment.

Reportedly, Americans for Prosperity have set up shop in Southeast Michigan to combat this year’s regional transportation campaign.
It’s difficult enough to convince people to spend money for the common good, much less when well-financed opposition is at work. Someone is going to have to come forth to defend these initiatives, and it’s unlikely that the government will, unfortunately.

Dennis Archambault is vice president for Public Affairs at Authority Health.

Governor, Legisalature must face consequences of Medicaid ‘work’ law

By Dennis Archambault

Michigan Senate Bill 897, which at this point is awaiting Gov. Snyder’s signature, will require able-bodied adults to maintain at least a part-time job in order to qualify for Healthy Michigan, the expanded Medicaid program. It actualizes a long-held desire by many legislators to force recipients to “have skin in the game,” or “earn” their social benefit. This is despite the assertion by several people working with safety net populations that most recipients of social programs work – some more than one job. And those who don’t work aren’t likely to work for a variety of reasons, most of which we would characterize as “social determinants of health.”

Recently, the Detroit Free Press published an interesting statistic: 53.4 percent of able-bodied Detroit residents don’t work. (https://www.freep.com/story/money/business/john-gallagher/2018/06/08/workforce-participation-detroit/674401002/) That’s largely due to lack of transportation, education, and skills. A large percentage of the population has re-entered society from a prison term. The Free Press didn’t provide a number that 53.4 percent represents, but in a city of 700,000 people, that represents a lot of people – a lot of people who will allow their health condition to worsen until they need emergency care. That, of course, means a lot of discomfort for people and a cost burden that some emergency health providers may not be able or willing to endure.

It’s unlikely that the unemployed will find work to maintain their health benefit. In a robust employment market like we have today, this population would be working.

The Michigan League for Public Policy has argued that “Having healthcare has helped people get and keep jobs, not the opposite… Aside from the complex bureaucratic red tape Medicaid enrollees will have to face and the increased administrative burden on our state caseworkers, this bill does absolutely nothing to address the barriers an individual faces in getting or keeping a job. In fact, it simply directs people to existing resources—resources in many ways that are significantly lacking. We have seen a recent uptick in conversations regarding transit, for example, with stories about trips in and around the Detroit Metro area taking two plus hours. And those stories don’t even account for bus delays, busses not showing up, or riders needing to get off a route to drop their kids at day care. Of course, many of the enrollees live in areas where transit just doesn’t exist.”

The legislators who remain in office long enough to monitor the effects of this legislation will eventually will face the unintended consequences of their action: increased demand on hospital emergency services for primary care and complications of diseases best managed in a medical home.

Dennis Archambault is vice president for Public Affairs at Authority Health.