Yesterday, I told you how government healthcare programs are getting bigger and how this is the wrong direction for the country. I also mentioned a relatively new theory from the Left – social determinants of health [SDOH] – that is about to make government healthcare programs even bigger.
Social determinants of health is the idea that social factors like housing, income, and employment have more to do with a person’s health than do individual risk factors like behavior and genetics. So, if you give poor people free housing, free food, free employment services, free education, free transportation, other free services, and guarantee their income, their health will get better. This will reduce hospital admissions, as well as overall health spending, the theory goes. At least that’s the cover story. The real agenda is radical egalitarian redistribution of income. But the theory sounds good. It sounds right. It sounds plausible. However, there’s just one problem. There’s very little evidence for this happy-face assertion. Billions have already spent on the theory, but the track record of real-world results is not good.
Unfortunately, that hasn’t stopped the government from rushing pell-mell into social determinants of health and into the arms of the people pushing it. The Biden administration recently announced it is giving states discretion to cover social services under their Medicaid programs.
No one is asking how much this is going to cost. The federal deficit is already $421 billion for the current fiscal year which began in October. Sorry, but Uncle Sugar doesn’t have unlimited pots of money. If the true agenda is redistribution, how much more do you think there is to get with a deficit like that? Would we even be talking about spending money on social determinants of health if we had to balance our budget? Also, no one is asking about the downsides. Nothing in life is perfect. Shouldn’t lawmakers be informed of the negative consequences before being asked to vote on such a thing? And speaking of Congress, this sounds like a major change that cannot be done by agency regulation alone under recent Supreme Court jurisprudence. So where is Congress on this? Are they falling down on the job again by not reining in agencies from committing us to huge new expenditures without congressional authorization? Why am I the only one asking these questions?
Tax-exempt hospitals spent $2.5 billion on social determinants of health – housing, employment, education, and food security – from 2017 to 2019. They are obligated to provide community benefit in exchange for their tax exemptions. But their spending on social determinants initiatives has fallen off more recently because the evidence such initiatives are effective is limited, a study found. Another study found social spending reduces unnecessary healthcare use but the costs outweigh the benefits. Other researchers found no association between overall community benefit spending and hospital readmission rates. These researchers concluded “the evidence for health outcome improvements from interventions focused on social determinants is thin…. This is very little evidence on which to base billions in investment….” The study concluding the costs outweighed the benefits found $3.4 million in healthcare savings after $22.4 million was spent on a social determinants case management program. Costs running seven times bigger than the savings – doesn’t sound like a smart investment to me.
This begs the question: if the evidence is so thin and even counter to what proponents claim, why proceed? Why is the federal government itching to spend more money on social determinants of health? Especially when social determinants theory has been criticized for ignoring the importance on health outcomes of personal choices and responsibility regarding alcohol, tobacco, junk food, drugs, and gambling. Moreover, in a previous commentary, I criticized social determinants theory for ignoring the magnet effect of free stuff from the government drawing ever-larger numbers of people into government dependency. Wrong direction.
The current administration has made no bones about working towards ‘equity’, ensuring equal outcomes, and redistribution. Social determinants of health theory – which comes from the redistributionist World Health Organization – is tailor-made for the Biden administration’s goals, whether the theory makes any sense or not.
In making its announcement states can add social determinants to their Medicaid programs, the administration said it will require states to show their social outlays are cost-effective, something the research has failed to show convincingly, so far. Whether the administration really means it is anybody’s guess, but Republicans on Capitol Hill need to police this to make sure the analysis is on the up and up and to shut the initiative down if it turns out it’s just another redistributionist boondoggle without any real benefit, aside from making redistributionists feel good about being so virtuous in giving away other people’s money.
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