Wednesday, October 14, 2009

The Costs of Sick School Children

I want to tease out a little scenario. Little Billy is a 3rd grader at Clinton Bush elementary school. One morning Billy wakes up with a fever. His mother, always concerned for Little Billy, keeps him home from school and takes him to see the doctor. Billy is given an antibiotic and stays home from school for a few days while his mother takes loving care of him. At least that is how it should work.

But let’s look at how things work in the real world. First of all, for a lot of Little Billys, there isn’t a mother who can stay home to care for him or take him to the doctor. She has to work to put food on the table. So instead of staying home, Little Billy, even though he is sick, goes to school. Chances are good that within a few days, several of Billy’s school mates will also be sick and their families will be in the same position as Billy’s. What are the costs to the families and community for all of those other sick kids? And what are the costs to the school itself for the days of missed attendance (especially in states where school funding programs are based on the number of children in attendance on any given day or ability to achieve certain test scores)?

And even for the Billys who are able to stay home from school, how many of them aren’t making a doctor visit? For too many families, there may be no insurance (or limited insurance) to pay for the doctor visit. Others may have insurance but need to self-ration their own healthcare because of inability to afford co-pays or deductibles, let alone medicines. In these cases, Billy may get worse or may miss more school than he should or return to school too early. In some cases, Billy may have insurance (through programs like CHIP), but his family may be unaware of the availability; even if that insurance is available, the family may not be able to take the necessary time to care for Billy.

Sure there is a cost to insuring Little Billy. But what is the true cost of Billy being sick for longer, of going back to school too soon and getting other kids sick, of additional children missing additional days of school, of parents having to weigh the importance of work versus caring for a sick child or medicine versus food? What are those costs to our society?

When my kids have a fever, they stay home. My wife can stay home with them. We keep them home for their own well being and so that every other child in their class is not exposed to their germs. But the number of times that I’ve heard about another child being sent to school with a fever or severe cough or runny nose and sneezing, is almost mind-boggling. What is the cost to my family when my children get sick because another parent either couldn’t or wouldn’t keep their child home? If another child pushes and injures my child, I can look that that family’s insurance to pay for the medical costs that my child will incur; if another child goes to school sick and gets my child sick, should I be able to look to that family’s healthcare insurance? (And if not, why not? Before answering, consider the following: If you are in an automobile accident with an uninsured motorist, you can usually look to a state pool that is funded by a premium for uninsured motorists that you pay as a part of your own insurance…)

The health of our children is our responsibility as parents. But the health of our children’s school mates is also our responsibility to the extent that our children are sick. That is a shared responsibility that we have as members of a community and civil society. We all recognize that our children shouldn’t hit one another; so why are so many parents unwilling to recognize their responsibility to be sure that their children don’t sicken others?

All of these costs impact our families and our communities. All of these costs impact the overall cost of healthcare in America. Yet I’m not sure that these sorts of “hidden” costs are being considered in the ongoing debate over reforming America’s healthcare system.

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