he money we invest in children has the highest rate of return of any investment a society can make. Healthy children cost less to raise and less to educate. They are more likely to live above poverty and avoid conflicts with the law. They are more likely to grow up to be well-adjusted individuals, productive workers, and responsible citizens. Children who are kept healthy by receiving preventive healthcare are key to the future of our economy, our national identity and our democracy.
Despite these truths, we are not investing in our children.
Of the world’s 21 leading developed democracies, 20 do better in child health than we do. Among the G7 countries, all have lower infant mortality and higher infant life expectancy rates. The infant mortality rate is three deaths per 1,000 live births in France and Japan but seven per 1,000 in the United States and 13.5 for black infants in Florida. In 1960, only 11 nations had lower infant mortality rates than the United States; by 2004, 28 nations had lower rates, including Cuba, Cyprus and Slovenia. Infant mortality is a key indicator of a nation’s health and the quality of its medical system; clearly, we are not doing well and are even falling behind.
Florida is 35th in the Casey Foundation’s ranking of child well-being among the states, and all other states in the 2008 Commonwealth Fund’s list of access to medical care for children do better than we do. Florida’s best child health score was 34th in affordability and cost of care, 43rd in equity of care, 38th in the potential for children to lead healthy lives, 47th in caring for special-needs children and 49th in the proportion of children receiving preventive care during the past year. This last ranking is particularly disconcerting because many of the most costly illnesses of adulthood begin during childhood and can be prevented.
Investing in children’s health is a federal, state and local government responsibility. Medicaid covers most children who are cared for in U.S. children’s hospitals, including those in Florida, yet children are only a small part of total Medicaid costs. Medicaid pays an average of $2,435 annually to care for a well child; while the same older adult costs $14,000.
Lack of insurance is the most frequently cited barrier to accessing healthcare. In 2006, Florida had the fourth highest number of uninsured residents in the nation. More than 18 percent of Florida’s children are uninsured — more than twice the national average, and the third highest percentage in the nation. This year’s government funding cuts have further impacted this shameful position. Yet, the increased funding needed to make the State Children’s Health Insurance Program available to all eligible children is less than 1 percent of annual Medicare spending.
Our politicians have to acknowledge the reality of the situation — the health of our children is critically at risk — and come to terms with the trade-offs needed to protect our most vulnerable citizens.
The political rhetoric on expanding care to cover the uninsured too often focuses on how many billions it would cost, yet many policy experts agree that implementing universal coverage, restricting payment to evidence-based medicine and rewarding preventive medicine could save money — as much as $1.5 trillion was cited in a recent New England Journal of Medicine article by Dr. Karen Davis. Reforming our healthcare system to be more inclusive can actually save money.
The United States is the only developed country and the only democratic nation that has no national healthcare system. We are similarly lacking a national mandate for the care of children. We need to see access to quality healthcare as a right, much as we recognize education as a right for every child in the United States. Access to affordable, high-quality, comprehensive healthcare is vital to our children’s well-being and our future. Please remember this fact when you evaluate candidates and their positions in the coming election. Florida’s four million children have no political voice of their own; we as voters must speak for them.
Steven E. Lipshultz, MD, is chairman of the Department of Pediatrics and associate executive dean for child health at the University of Miami Miller School of Medicine.