Yeah, hon.

The interesting thing about electoral politics is what a fine line there is between saying enough to intrigue and be clear on where you stand while not saying too much to box you in or to go beyond what's appropriate to say at that stage in the game.

Obama released his health policy plan today (full plan is a .pdf here). He and others debated health care a few months ago in rather vague terms. To be fair, this campaign is still young to expect specifics. However, only Edwards had a concrete plan by the March discussion.

Both plans, and almost all of the discussion, are about health care. They rarely extend beyond the realm of insurance costs; if they do, it is with great trepidation. Obama's plan is much more inclusive than Edwards, but these plans are about reforming the system of care and not necessarily about improving health itself. They don't claim to be something they're not, and with good reason. Voters don't care to hear a candidate's plan to reduce known distal causes of ill-health; they want to know that their co-pay is going to go down for their medications.

There's a discernible finger-pointing in this strategy. But, as a saying goes, when you're pointing a finger, there are four pointing back at you, or in this case, all of us. This "fix-the-system" talk is necessary--the health care system is clearly broken, with a lot of people going bankrupt and dying as a consequence. But the health care system--system like doctor/hospital/patient, payer/payee--is no less or more broken than Americans' own health behaviors. No one is asking The Big Question about why and how Americans are sick. A perfect Medicaid system will not address those issues; in fact, it will be a mere Band-Aid.

I understand how and why candidates have to address those issues, but as the campaign goes on, I hope to hear more about health and not just health care. I think that a smart candidate will champion the issue in a broader way than just policy-wonking on payment systems, and I think Obama could do it well.

I certainly have my own bias here: I'm going to work for two months to look at, in large part, the health effects of a poverty-reduction program and am in a department that thinks about social determinants of health. I was just reading a really well-written review of two new books on AIDS in Africa in which one author put what I've been trying to say here very succinctly, "I was still subject to magic bullet thinking--the idea that serious public health problems could be addressed without considering their social and political causes."

I have been thinking a lot lately about the work I'm about to do, both small and big-picture perspectives, and am watching my own professional and personal interests evolve. It's so nice to have the mental freedom to think big thoughts again, to re-engage with what I care about instead of forcing myself to care about getting the next assignment done. I'm getting the feeling more and more that this summer is going to be a great chance to breathe a bit, get some perspective on this past year, and take stock before coming back again in the fall. At the very least, without 24/7 internet access, there's certainly going to be plenty of time to think. And write long posts like this one.

Labels: election, health, malawi, professional ramblings