America is struggling with the worst economic crisis of a generation. Even before he takes office, President-elect Barack Obama is besieged with advice about what he should do — and which of his campaign promises he should forgo — to turn things around.
Conventional wisdom holds that the economic meltdown is distinct from issues such as health reform on which Mr. Obama campaigned. But conventional wisdom is wrong.
The economic collapse and the health care crisis are, in fact, intrinsically linked.
Long before the subprime mortgage mess begat the implosion of major investment banks, which gave birth to the banking crisis that spawned what now probably is a major recession, a sense of dread had infected middle-class Americans.
It was rooted in the stagnation of their incomes over the past eight years. And, in a larger sense, in what Yale University political scientist Jacob S. Hacker has called the “great risk shift.”
That’s his term for a 30-year-old erosion of social insurance and safety net programs, including pensions, unemployment and disability insurance and private health insurance. All help cushion the impact of sudden economic changes.
That’s a major reason why, even when most economic indicators were relatively good, voters were telling pollsters they were concerned about the economy.
Medical debt is one of the leading causes of bankruptcy and home foreclosure in this country. No wonder that, when voters were asked by the nonpartisan Missouri Foundation for Health to name their top economic concern, they chose health care.

Fixing our dysfunctional, fractured health system won’t, by itself, solve the nation’s economic crisis. But ignoring it will make that crisis worse.
One part of any new economic stimulus package, most experts agree, should be assistance to states. The shrinking national economy is playing havoc with state revenues at the very time that demand for state services — such as unemployment insurance and Medicaid — is growing.
During the long campaign, Mr. Obama talked about a mandate that all children have health insurance. Understandably, he may be reluctant to impose it during hard times.
But he should ask Congress to expand the popular State Children’s Health Insurance Program, as it tried to do last year. SCHIP covers children in families earning too much to qualify for Medicaid but not enough to buy insurance on their own.
Even many low-wage workers who still have jobs are losing health insurance or the subsidy that helped them cover their children. An SCHIP expansion would allow those kids to continue receiving health care. That pays off in improved school performance and healthier lives.

The current health care crisis provides an opportunity to accomplish something that a half dozen previous presidents have tried and failed to do: Create a more rational health care system that covers all Americans.
As soaring health costs put care out of reach from growing numbers of America’s middle class and as those increased costs weaken the economy and make American products and companies less competitive internationally, new coalitions for change are forming.
They include traditionally antagonistic groups like big business and labor unions.
The spouses and children of aging Americans, who see their entire life savings depleted by the costs of end-of-life care, recognize the need for change. So do growing numbers of middle-class families who see themselves priced out of care their doctors say they need.
Fundamental change must include ways of controlling health costs. National health spending has nearly doubled over the past 10 years, and it’s expected to double again in the decade to come. Yet there has been no corresponding increase in health quality or outcomes.
Mr. Obama hardly needs any more advice, but we’d suggest that you can’t fix American’s economic crisis without addressing its health care crisis. Do that, and they’ll make room on Mount Rushmore.