When healthcare systems and not-for-profit social service providers step up to provide food, housing and transportation assistance to needy patients, they often discover government cutbacks undermine their efforts.
The U.S. spends less than other advanced industrial nations on social services—about 4% of gross domestic product. The average among other rich countries is around 10%.
That spread is growing worse under the current administration. Supplemental nutrition programs are being cut; waiting lists for housing assistance are growing longer; comprehensive programs to address the nation’s behavioral health and opioid crises are, to be charitable, still in formation.
“There’s not much of a social safety net anymore,” says Dayton Mayor Nan Whaley, whose Ohio city was the scene of a mass shooting this year. She recently spoke at the national summit of the Root Cause Coalition, which has grown to more than 75 health systems, hospital associations, foundations, businesses, and national and community-based charities committed to addressing the so-called social determinants of health.
The 650 practitioners who gathered to learn best practices in their field heard a sobering message from a panel of small-city mayors. “We don’t have the resources,” said Toledo, Ohio, Mayor Wade Kapszukiewicz.
The nation pays a huge price for this short-sighted approach to social services. It comes in the form of spending more on caring for the sick, at present a world-beating 18% of GDP.
As studies have repeatedly shown, wellness and longevity are directly related to a person’s income, education and social status. The incidence of chronic disease and acute medical crises rises dramatically when families can’t afford a healthy diet; when people skip physician appointments because they have no access to public transportation; and when kids live in lead-filled and roach-infested apartments.
Americans consider affordability their No. 1 healthcare concern. Yet few make the connection between underinvestment in social services and their own healthcare bills.
Private payer rates are as high as they are in part to make up for the shortfalls in payments by public programs, which is where most people suffering from the ill-effects of poverty wind up. Investing more in social programs will reduce healthcare spending for the poor, which in turn will lead to less cost-shifting to those in employer-based plans.
It’s not just Medicaid. Nearly half of Medicare beneficiaries live solely on Social Security. That leaves an estimated 7 million of the nation’s elderly living in poverty with 5.5 million considered “food insecure,” according to researchers for the Meals on Wheels program.
The number of elderly people needing food assistance nearly doubled from 2005 to 2017. Yet the number of meals delivered by that program, which gets 39% of its funding from the federal government, declined by 21 million annually over the period because food, transportation and other costs have increased while funding remained stagnant.
Think about that lost opportunity. When fewer people show up in seniors’ homes, where 1 in 4 live alone, it increases social isolation, a major contributor to senior ill health. Another set of eyes never sees the potential hazards that can lead to falls. No one identifies ahead of time the gradual deterioration in health status that eventually leads to expensive hospitalizations.
The National Academy of Sciences recently called on healthcare organizations to integrate social care into the provision of healthcare. A forthcoming report from the Root Cause Coalition will list as its first “call to action” healthcare payment reforms that will allow providers to help finance the redress of social inequities.
Healthcare organizations need to be part of the solution, of course. Charitable foundations should do more to help the not-for-profits doing remarkable work locally. But repairing our tattered social safety net first and foremost requires a much larger federal commitment.