I’ve spent my career in health care policy, working to make sure families have easy access to quality health care. As such, I’m acutely aware of the difference between individuals getting access to affordable health coverage versus public health overall, the effort to maintain and improve the health of populations. And with the COVID-19 pandemic I guess we all are getting a short course in how public health works to try and control disease with measures like physical distancing, contact tracing, testing, and vaccine development. But one lesson I learned a very long time ago is that successful public health efforts and the need for Americans to have access to quality, affordable coverage are inextricably linked. You simply cannot have one without the other.
The best example of this is from my own experience. Some of the most dedicated people and organizations I’ve seen work on improving access to affordable health care over the years were in the field of public health. Some were professionals who make local public health departments run, overseeing the tedious work of inspecting restaurants for health violations and tracking down community members to vaccinate and refer to treatment contacts of people who have communicable diseases such as the measles. Others were state public health administrators who collect data, identify patterns in emerging epidemics, and suggest solutions to stop infectious diseases in their tracks so as to prevent tragedy instead of trying to treat the aftermath.
These public health partners were always willing to not only work on their primary mission of population health but also to work on expansion of health coverage for individuals. Partly, this was because states over the years began to saddle many local health departments with a task that they shouldn’t have to do: Operating primary care health clinics to serve growing numbers of uninsured residents. But treating the uninsured put many in public health on the front lines of the uninsured crisis. Public health workers also are answering a moral call to service to improve the lives of their fellow Americans. And today we are seeing that as never before. But the heart of public health sector’s dedication to affordable coverage is a simple truth: Some of the most important public health interventions are unable to achieve their goals – such as in today’s most urgent case of “flattening the curve” — unless they are coupled with a health care system where sick people can go to the doctor and hospital without worrying about going bankrupt.
Looking at the top ten public health achievements of the last century of course includes non-treatment dependent measures such as the establishment of clean drinking water and sewage systems and the stunningly simple idea that consistently wearing a belt in a vehicle traveling at high speeds can actually save lives. But public health’s greatest hits include the defeat of terrible communicable diseases, such as smallpox, and the introduction and use of vaccines across the board to sharply reduce the threat from all sorts of disease. And the key to universal vaccines is universal access to the health care system to get them. The century old public health method of identifying people suffering from a communicable disease, tracing their contacts, and limiting spread rests on testing and treatment delivered in health care settings. Public health’s success in spurring large reductions in tobacco use leading to major drops in lung and heart disease depends on not just social change but treatment and advice from the medical system. And public health campaigns that drove huge declines in death rates from coronary heart disease and stroke are completely intertwined with simple access to quality, preventive care and long-term treatment options for millions of Americans.
Public health measures and individual access to quality health care treatment are indisputably two sides of the same coin.
As we move forward through the dreadful uncertainty that the current pandemic brings, it is imperative that we adequately fund our public health professionals and infrastructure to a standard that keeps all Americans safe. Too often over the years, I have watched public health departments and systems starved for funding – not once, but again and again. This must end immediately. Today we can all see the desirability of a robust public health system that can identify, treat and stop epidemics. And we will be relying on our public health system in the coming months to help us attack the current pandemic in multiple ways to save lives and help communities respond, adjust and recover.
We must then make sure that our strengthened public health measures are coupled with changes to assure quality, affordable health care for everyone. And let me be clear — these are longer term measures that go beyond the obvious immediate critical need to properly equip our heroic health care providers with personal protective equipment and enough medical technology like ventilators that are basic necessities that allow them to do their jobs of saving hundreds of thousands of lives. We must address these shortcomings as soon as possible, but doing so will not solve our affordable coverage problem.
One simple change that will absolutely improve affordable coverage and could be achieved quickly exists in 14 states. Leaders in the 14 states that have refused the available federal Medicaid expansion funding could do so immediately and over two million people would be able to access doctors, hospitals and treatment without worrying they will go bankrupt from the cost. Reversing the shameful increase in the uninsured rates of our nation’s children should be another effort. And other robust improvements in the existing system to ensure no one is left out should be at the very top of our agenda. People need help now, not more red tape barriers to health care and debate – which is why it was excellent news that federal legislation responding to COVID-19 provides continuous Medicaid eligibility for the duration of the public health emergency to all current beneficiaries and new enrollees (unless they move out-of-state or request to no longer be covered).
In addition, states are getting fiscal relief to help them respond to the increased need as people lose their jobs or see their hours or wages cut. But there is still much more left to do. Be sure to follow my colleagues here as we analyze federal and state efforts around the current crisis.
Our public health professionals and health care providers are on the front lines as never before in our nation’s history. As we move forward, our funding and systems need to be updated to support their efforts like never before as well. Our nation today faces a moral test. As we meet the needs of the current crisis, can we build and fund our public health system to a standard that will protect every American? And can we couple that public health system with the other crucial elements necessary for success — a guarantee that all Americans can seek and receive quality health care treatment without risking financial ruin?
