According to Nicholas Kristof (“Unhealthy America,” NYT, Nov 5), “Opponents of reform assert that the wretched statistics in the United States are simply a consequence of unhealthy lifestyles and a diverse population with pockets of poverty.” Well, it’s true – there are wretched pockets of poverty, and that’s the principal reason that our statistics are worse than those of other countries. But pointing out that poverty is a major source of poor health and that health care reform has failed to address the issues of poverty does not make me an “opponent of health care reform” (see “Questioning the Reform Agenda: How Poverty Affects Costs and Outcomes”). It make me an advocate for reform that will actually deal with health care spending; reform that will improve the health of millions of poor Americans who will never attain anything close to the health status that Kristof and I are privileged to enjoy; and reform that will lead to the kind of equitable society that Kristoff and his wife, Sheryl WuDunn, yearn for in their important new book, “Half the Sky: Turning Oppression Into Opportunity for Women Worldwide.”
How curious that supporters of reform see the need to minimize the impact of poverty on geographic variations. And how sad that, by failing to appreciate the role of poverty, the current reform legislation sets the wrong policy related to hospital readmissions, establishes faulty systems of bonuses and penalties related to geographic differences and decreases disproportionate share (DSH) payments on behalf of the poor. There’s a lot that’s right in the health care reform bills, but the negative impact they will have on hospitals and physicians who care for the poor has to be fixed. Then we could have real health care reform.