To see the origin of this post, go here. Today, I continue to lay out a positive vision for what I would like my community and nation to become.
I envision a nation where every resident has access to primary health care within no more than 20 miles of their homes. This care would not require co-payments or annual deductibles. It would include community health workers who would visit vulnerable populations in their homes with no community health worker serving a populaiton of more than 1,000 citizens.
You have heard the news: the US spends by far the most of any economically wealthy nation on its healthcare, and yet its citizens’ health outcomes rank at the very bottom.
Our neighbor to the south, Cuba, has a life expectancy at birth higher than in the US. And while many consider Cuba to be a pariah, its citizens live longer on average—despite being far poorer.
Obviously there are many reasons for this.
Among them is how we think about what health and healthcare mean and what access to healthcare looks like.
Unless you are extremely poor, access is mediated by large “insurance” and healthcare companies whose goal is to limit use, reduce treatment costs, return large profits to shareholders, and control all aspects of the drug, health specialist, and hospital markets.
They are for-profit healthcare exclusion organizations. This system leads to the high costs and poor health outcomes we seem to take for granted. Like everything, this system did not just emerge but evolved out of tax codes and policies that encouraged it. It is the product of highly successful lobbying by “insurers” and the dogged pursuit of “efficiency” in the name of economies of scale.
It is only marginally about health but provides its own figleaf by paying doctors, nurses, and technicians and running what looks like health-providing organizations (primarily hospitals).
That is a bit about our system, but what about how we view health and healthcare? While primary prevention has been promoted for over a generation: stop smoking, drink less, exercise, get a flu shot, etc., the big money is spent on secondary and tertiary prevention—essentially keeping things from worsening and preventing death.
(I relax by watching the World Series or a Saturday afternoon football game. It also illustrates our healthcare approach as advertisement after advertisement extols the virtues of expensive medications for serious chronic diseases. Immunizations, for example, get little airtime and are provided as public service announcements.)
In addition, our nation’s income and wealth inequalities, combined with virtually unrestricted and aggressive marketing of unhealthy products, mean that the cheapest and unhealthiest foods flow to the poorest members of our communities—many of whom are priced out of appropriate healthcare. There is scant time to focus on prevention, and everything in the ambient culture seems to promote poor health.
Healthcare providers live behind institutional arrangements where access is strictly limited and supportive health information is most readily available on the internet—if you are savvy enough to find it through waves of misinformation and have access to the medium.
In this regard, I am not suggesting active collusion between the industrial health and industrial food complexes. I am only saying that both are driven by an insatiable desire for profits and not the health of the people who consume their products.
A visiting lecturer in the MPH course I co-facilitate recently returned from Cuba and shared their experience visiting with people delivering primary health care there. I was struck by the humanity of it all: ready access to regular check-ups, doctors who live in and serve the communities where they live, and community health workers who extend care and provide needed information and support.
But, yeah, it’s Cuba…
I guess we prefer “freedom.”
While the Affordable Care Act has extended insurance to many millions in our nation, I am not convinced it has extended better health outcomes. I am not sure it has led to a boom in preventive resources—more frequent primary healthcare visits, better food options at fair prices, more focus on supporting healthy choices.
You may ask why it is the responsibility of a health insurance plan to ensure healthy food. I will answer that many of the chronic conditions we face have their origins in what and how much food we consume.
I harbor little hope that we can tear down these industrial complexes, but we must name what they are if we hope to try.
Traveling at the Speed of Bike 