Reimagining Healthcare as a Community Investment

Let us be clear: Guaranteeing medical services as a right to all Americans is not only a moral mandate, it is an investment in individual freedom and capacity, in family security and opportunity, as well as community solidarity and peace.

The rest of the mature developed world places this priority along side fire departments, schools, and housing as collective public goods guaranteed by the government. Here in the USA this moral mandate has been retarded first by racism (those states which did not expand Medicaid under ACA mostly belonged to the Confederacy, Arizona with its indigenous and Hispanic populations was the last state to create Medicaid) and then by greed as corporations have learned to make great profit from illness and suffering - Covid, for example, may take an economically speaking worthless grandmother from her nursing home to the hospital where she becomes a $100,000 or more profit generator.)  The self serving small government Republicans and the just plain selfish Libertarians promote the myth that freedom resides in individual choice. Thus they are free not to mask and to randomly succumb to the Virus, while imposing the costs and the vulnerability on the rest of us. It seems about 30 percent of Americans agree with them. Hopefully finding 120,000 (and counting) Americans dead will change the discussion in the public square and raise the value of collective health services to be equal to education, fire stations and the military.

Functioning as clinicians within the immoral environment of American medicine has produced an epidemic of burnout among American doctors. This is a moral injury. American medicine's true nature has been highlighted as professionals and clinicians all over the country have stood up without hesitating to meet the challenge of the Covid Pandemic, facing an overwhelming onslaught  of suffering and dying  isolated patients in spite of intense personal jeopardy and risk due to our collective inability to supply them with necessary personal protection. Why should their heroism be so outstanding? Where the hell is everyone else?

While child abuse is not restricted to the disadvantaged, it is certainly facilitated by the stressed circumstances of the impoverished. This is an epitome of the bigger picture we have been discussing. Once again as clinicians we do our best with band aides, while the best solution requires social transformation. Raising a healthy child requires a healthy village. Every medical professional should be a politician.