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Medical Indebtedness, Financial Insecurity, and Health — Time for a Government Bailout?

Unless you’ve been traveling through another solar system, you undoubtedly have heard about the recent crises in U.S. financial markets. Prompted by a wave of defaults on what turned out to be highly speculative subprime mortgages, and reinforced by the plunge in housing prices, accelerating rise in the price of oil, and competition from the global economy, financial markets reeled with potentially devastating consequences for U.S. lending institutions and their international financial partners. The crisis appeared to peak in mid-March, abating only when decisive action by the Federal Reserve System bailed out debt-ridden financial titan Bear Stearns. Although the dust has settled as of this June writing, the U.S. economy and its financial system remain fragile, and talk of reform, greater scrutiny of financial practices, and future bailouts by government remain on the front burner. Although the chaos in the financial, housing, and energy markets is perhaps the most graphic example of recent economic instability, the growing insecurity and diminished economic prospects faced by many American families remain prominent and longstanding concerns. Recent opinion polls reveal the public’s perception that we are in the midst of major economic problems and crises. For example, in a Gallup poll conducted at the end of April, an estimated half of all Americans cited declining real wages, job losses, and rising health care costs as major problems for the U.S. economy; a fifth said wage declines and job losses had reached a crisis, and 28% asserted the same for rising health care costs. Year-to-year volatility in family incomes has also increased over time, and together with uncertainty over job security and the deterioration of the traditional private safety net of pensions and health insurance, families are facing significant financial risk (Gosselin and Zimmerman 2008; Hacker 2006; Leonhardt 2007). Finally, income inequality has increased broadly over the last two decades as the top 1% of earners experienced after-tax income growth of 201% compared to only 15% for those in the middle quintile (Frank 2008). Accompanied by the decline in intergenerational income mobility, such inequality threatens the American belief that by working hard, using your talent, and playing by the rules, one can get ahead (Sawhill and Morton 2008). After reading this far, you might be asking what these considerations have to do with health policy and with population health. I can think of at least three compelling ways in which the recent chaos in financial markets and our growing unease over economic security have both direct and indirect implications for such issues. These include the following: