Employer-funded, high deductibles, Obamacare, the ACA, pre-existing conditions, mandates, freedom to choose, high premiums, privacy, single payer, etc., etc. The debate over how to pay for healthcare has been tearing this country apart for years. The topic is a minefield of assumptions, misinformation, fears, and loaded language and seems to defy resolution.

Now, take a moment to consider, what is the difference between being healthy and getting healthy? In a heartening TED talk, Rebecca Onie, an expert on the intersection of social determinants of health and healthcare, shares some startling findings (ted.com/talks/rebecca_onie_what_americans_agree_on_when_it_comes_to_health/transcript?language=en). When polled about what we need to be healthy and how to allocate a hypothetical pot of money among those things, there was almost total agreement across genders, ethnicities, regions, and political parties. The citizens
of this country may rage and wage war on one another about health insurance, but they agree on what is fundamental to being healthy—safe housing, healthy food, good wages, and health care.

The responses are thrillingly unanimous. Whether the respondents were African-American Democratic women in Charlotte, white and Latino male swing voters in Seattle, or white male Republicans in Dallas, if given $100 they would all spend more on housing, food, and childcare rather than in hospitals and clinics. The color-coded pieces of Onie’s pie charts make abundantly clear the broad agreement across all polled groups on how to spend dollars to help people be healthy. What better place to start building?

In recent years, awareness of the importance of “social determinants of health” has grown. Onie points out that today it is “widely recognized that just 20% of health outcomes are tied to medical care, whereas up to 70% are tied to healthy behaviors and what’s called the social determinants of health—basically, everything that happens to us.” That’s quite a disparate impact. Health care providers acknowledge that better housing reduces infant mortality and increases life expectancy, and doctors bemoan sending patients home to unhealthy housing or insecure food availability, yet Medicaid can justify doing nothing for hungry patients as the “standard and usual care” in this country. 

Most voters have experienced struggles to make ends meet. For them, regardless of party affiliation, it is common sense, based in experience that good wages, healthy food, and safe housing are important to health, and they agree on how to apportion the dollars that could keep us healthier. As Onie concludes it is “not about changing minds… It is about changing the questions we ask...and it is [time] to act.”

We the people can help all to be healthier by reminding healthcare and insurance businesses that we expect them to make the data about non-medical influencers of health a part of their business plan.

Let’s stop arguing and start acting. In 2017, national healthcare expenditures grew to $3.5 trillion, or $10,739 per person, and accounted for 17.9% of the US GDP (cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet.html). If we put funding toward things that help us to be healthy, less healthcare will be needed.

Next, try this for other contentious topics. Step back from the most hotly-contested position to find the underlying common ground and build from there.