Category: Zachary Janowski

I first got interested in health equity because of Medicaid. I applied for the Connecticut Health Foundation’s fellowship even though I didn’t know much about racial and ethnic disparities because I thought, I know about Medicaid and that’s a disparity in and of itself. I often disagree with other health equity thinkers because I’d rather not have the government try to fix complex problems because that often comes with negative side effects. Imagine if there was a health condition with the same characteristics as Medicaid. If there was, I think more traditional health equity thinkers would go crazy. They would demand the government intervene to help.

Please get mad that the Treasury Department is delaying the mandate that employer’s buy insurance for their employees (sometimes). While, I am no fan of the Affordable Care Act, more is at stake here. Our political system is built on the rule of law. Process matters more than policy. (If you doubt this, take a second to think about our unintelligible policies on immigration, punishing criminals and healthcare, to name just a few.) If the Executive Branch has the power to delay a law – passed by Congress, signed by the President – what can’t it do. Now, if a President wanted to make the argument the law was unconstitutional i.e. a violation of our most fundamental law, that would be one thing. But the idea that a portion of the ACA is inconvenient for businesses, or that insurers need more time to upgrade their software before out-of-pocket spending caps can be enforced, may be unpleasant. Fine, but who cares….

Many passionate people are baffled by the media’s coverage of health disparities. Please know that ALL experts and EVERYONE who is passionate about a particular issue feel their topic is neglected. The first mistake you can make is that you are being singled out for poor treatment. Not so. When I used to edit a weekly newspaper, I often told people that my most frequent decision is to NOT put something in the paper. Only a small minority of topics are addressed in each edition. What can you do to improve your odds? Here are my 7 tips.

How is this for counter-intuitive? The best way to improve health in our country is to have the government spend less on it. In some ways I agree with my fellow contributor, Ashley Fox, when she points to the importance of social determinants of health (although I disagree on economic inequality as I pointed out here). Here is my hypothesis. If you believe in the social determinants of health, you should want the government to spend less on healthcare. The simplest way to understand social determinants of health is this equation: healthcare ≠ health.

If someone offers you half of pie #1 or all of pie #2, the  first thing you should ask is, “How big are the pies?” I don’t know when it started, but many Americans have forgotten to ask this question when they look at income inequality and the  redistribution of wealth. The conventional wisdom is perhaps correct that wealth is now more concentrated, but that is relatively unimportant because the amount of wealth is not fixed. It is entirely possible for wealth to become more concentrated and for EVERYONE to be better off.

Like my fellow contributors to Health Justice CT, I believe that racial and ethnic backgrounds have too much of an effect on health outcomes. Thedata in support of this belief is strong. Where I may disagree with my fellow contributors and others who care about this issue is how the problem is best solved. The best way to address racial and ethnic health disparities is through civil society, the institutions and relationships formed by the residents of Connecticut without the involvement of the state government. Unfortunately, many medical charities have stopped using their money to directly help people.Instead, they use the money they raise to lobby the government. Success at this gamble can turn thousands of dollars into millions.