That has been essentially the nature of the public debate over the Build Back Better bill. It costs too much, we can't afford it! Yes can! Actually it costs far less than the military budget over the same period and nobody seems to think that costs too much. But whether BBB costs too much actually depends on whether it's worth it. The Health Affairs blog breaks down the critical -- and I do mean critical -- public health needs that BBB addresses, and actually doesn't spend enough on. As they summarize:
The range of population health matters these amendments address is quite breathtaking: the long-term care needs of an aging nation; the nation’s maternal mortality crisis; mental illness; gun violence; medically underserved communities; and more. Collectively these important initiatives are grounded in the principle of health equity and will act jointly with the BBB’s strengthening of health insurance to support the health of the poorest and most vulnerable Americans.
What I want to focus on particularly is the serious shortage of home and community based services for older adults and people with behavioral health disorders. As the population grows older, we'll need more than 1 million home health and personal care workers. We also have people stuck in nursing homes, and in prison, or homeless, who have mental health and/or substance use disorders. With supportive services, these people could live in the community at far less cost and with much greater dignity. BBB invests in the home health workforce, and the peer recovery workforce, and if we can keep people out of nursing homes, that can actually save money.
The BBB also invests in infrastructure to meet the next public health crisis, which does seem like an awfully good idea. The senate needs to pass it. Cut the crap.
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