Beyond the Public Option

For the past two years, New York City has been running an experimental pilot program called OpportunityNYC, in which poor people — mostly black and Latina single moms and their kids — are paid for "good behaivor." In the Prospect's current print issue, I report on how that program is faring. While the jury is out on whether cash incentives can improve academic performance or encourage single moms to find part-time work, it seems that monetary rewards work quite well when it comes to encouraging good health: Forty-five percent of all Opportunity NYC payments were for health-related activities, compared to just 18 percent for work-related activities. Families enrolled in the program can earn $600 per adult for maintaining private health insurance, or $40 per month for enrolling in Medicaid. Each child or parent can earn $200 for an annual medical check-up, $100 for a recommended follow-up exam, and $100 for a visit to a dentist.

Opportunity NYC is an interesting lens through which to view the health reform debate. The goal of these health rewards is to incentivize preventive care — the kind that's cheaper to provide and keeps people from developing more unpleasant health problems later on. This is important for drastically poor children, of course, and for their moms — the people who are enrolled in Opportunity NYC and who already qualify for public assistance.

But it's also important for young women who might become pregnant, and whose health at conception affects their baby's birth weight and neurological development. It's important for urban gay men of color, the nation's highest risk group for HIV infection. And it's important for immigrant construction workers, who do dangerous jobs that jeopardize their health, but who often don't have employer-provided health insurance.

All these people are costing our health care system a lot of money, because they don't qualify for Medicaid and can't afford to purchase their own private insurance coverage. That's why — as we feverishly debate the public option — we can't lose sight of the other elements of health reform. The health reform legislation in front of Congress would expand Medicaid coverage to poor single adults of both genders. It would likely guarantee prenatal and maternity care. It would provide subsidies that help poor people afford decent medical care.

The lesson of Opportunity NYC is that given government support, health care is one of the first things people access. It's important to them, especially if they are parents.The payoff to society is that when we maintain good health through preventive care, we don't have to pay for drastic interventions later on. The long-term savings of a more humane health care system are impossible for the Congressional Budget Office to conclusively score. But in our quest to "bend the cost curve," let's not leave common sense at the door. This isn't really all that difficult to understand.

cross-posted at TAPPED

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