By KIM BELLARD
In a week of watching the failed Afghan withdrawal, Texas has shown us its contempt for all kinds of rights, watched wildfires ravage the west and Ida wreak havoc in a third of the country, and, of course, Witnessing COVID-19 continue its resurgence, I managed to find an article that depressed me even more. Thanks, Aaron Carroll.
Dr Carroll – pediatrician, longtime contributor to The New York Times, and now IU Health’s Chief Health Officer – wrote a surprising article in Atlantic: We have never protected the vulnerable. He looks at resistance to public health measures like masking and wonders: why is anyone surprised?
Some of his more pithy observations:
- “A large part of the public refuses. This is nothing new, however. In America, it has always been like this.
- “COVID-19 exposed these gaps in our public solidarity, did not cause them. “
- “America never cared enough. People just didn’t notice it before.
Wow. What was it again in Texas?
Some of Dr. Carroll’s examples include our normally nonchalant approach to the flu, our inability to recognize the dangers we often pose to people with immunosuppression, our paltry policies for families and sick leave, and our vast economy of unpaid care. He might as well have shown our (willfully) broken unemployment system or the stubborn resistance to Medicaid expansion in 12 states (Texas again!), but you probably get the point.
Everyone likes to complain about our health care system – and with good reason – but it’s not an abyss we’ve fallen into one way or another. It is a hole that we have dug for ourselves, over time. We may not like our health care system, but it is the system that we created or, perhaps, authorized.
Health insurance was once widely valued by the community, spreading risk evenly among all to protect the burden of the sickest, until some insurers (and groups) discovered that premiums could be cheaper without it. . The use of pre-existing conditions and medical underwriting also served to protect the less vulnerable, until the ACA outlawed these practices.
Fee-for-service wasn’t much of a problem until Medicare came in and pumped billions, then hundreds of billions, into the medico-industrial complex. Healthcare professionals and organizations quickly realized that there was money to be made in healthcare. Some doctors earn millions each year from Health Insurance and or pharmaceutical, and some hospitals sit on billion dollar endowments, but the problem is less that a few earn as much money as so many others earn a lot of money. This money comes from the rest of us.
The same business leaders who sit on hospital boards and / or make big contributions to these hospitals also complain about the impact of their employees’ healthcare costs on their bottom line. The same leading physicians who have made our medical schools the most and the most expensive around the world warn of medical school debt and impending physician shortages. Neither connect the dots.
Public health was once a valued public vocation, with public health measures making huge progress in the protection of the public during the first half of the 20e century, for example by reducing infectious diseases, fluoridating water and improving food security. The 21st century, on the other hand, saw alarming declines in the financing of public health, by creating a “hollowed out“Public health system when we needed it most. The pandemic has seen public health officials ignored, ridiculed, even threatened – causing “mass exoduses“from them. We are the ones who are really hurt.
The polio vaccine was a great public health success, with almost universal compliance, but the anti-vaxx movement was gaining strength before COVID-19 appeared. A COVID-19 vaccine has been developed and deployed in record time, and we wouldn’t be facing Delta’s surge right now if most of us had been vaccinated, but we still have a fifth of the population who still say they will not get vaccinated. Their “rights” directly affect our well-being.
Healthcare professionals, especially those who work in hospitals, have been true heroes during the pandemic, especially since they battled outbreaks last year and, sadly, must do so at new now. Although compulsory vaccinations are nothing new for healthcare workers, many are now resist receiving the COVID-19 vaccine – protest or resign / be fired instead of. They risked their lives caring for patients, but now they are putting vulnerable patients at risk.
We love the jobs created by healthcare, but complain about the high price of health care. We hate health insurance companies, but we realize that we could never afford the most expensive care without some sort of insurance. Money spent on health care is not money spent on other needs.
We are frustrated with the wait, red tape, delays and lack of transparency associated with our healthcare providers, but not only do we tolerate them, we don’t even demand proof of excellence, or even skill. We activate all faults.
Most of us have had a family member who needed some sort of long term care (custody), but this is not covered by Medicare or private health insurance. . Most of this care is paid by Medicaid – after spending most of the assets – or out of pocket, and ignoring any unpaid care provided by family or friends. Talking about vulnerable populations …
Our politicians brag that the United States has the best health care in the world, but it compares very poorly to other rich countries, with some of our results, like maternal health, positively third world. The racial disparities in our health care system is further proof that when it comes to protecting vulnerable populations, we prefer not to.
So, yes, Dr. Carroll is right. In America, we have always taken care of ourselves more than the vulnerable. The gaps in our public solidarity have been with us for a long time. As much as we like to think of ourselves as caring people in a caring nation, the sad truth is, we never cared enough.
As a result, we now have a health care crisis that doesn’t have to be so severe, and we are underserved in a dysfunctional health care system that we probably deserve. At this point all I can do is hope Dr. Carroll is also right that people just haven’t noticed how selfish we can be, let alone realize the consequences for them. most vulnerable populations – and that this will inspire us to do better. .
Is it selfish of me?
Kim is a former emarketing executive for a big Blues plan, editor of the late and late Tincture.io, and now a regular contributor to THCB.