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If you tried to design a weapon customized to exploit every weakness in the U.S. health care system, you might have come up with SARS-CoV-2: the novel coronavirus.
The pandemic caused by that spiky virus, now in its second year, has rampaged across the country in part because our disease defense system — the critical but neglected discipline known as “public health” — has been so starved of resources for so long that it had been effectively dismantled before the coronavirus arrived. Without robust disease surveillance, stockpiles of emergency equipment and a skilled public health work force, we were all but defenseless.
As a result, for the past year, Americans have watched as their vaunted health care system, with its massive hospitals, top-flight surgeons and expensive technology, struggled against an enemy best fought with low-tech measures like wearing face masks and staying home.
We knew our health care system had deep flaws: Too little emphasis on prevention and primary care. Clunky data systems. A porous mental health system. Deep health disparities, arising from poverty, racism and decades of neglect.
High costs. Uneven quality. And despite the gains of Obamacare, a lot of people who still can’t get affordable care at all.
And under it all, there was a deep, dangerous erosion in the social foundation of public health: trust. Trust in science, in medicine, in expertise, in government and in one another. Our national lack of trust will make recovery and rebuilding from Covid-19 that much harder.
“This pandemic has really exposed the failures of our health care system,” said Rep. Raul Ruiz (D-Calif.), a physician who represents a heavily Latino district in southeastern California and who leads the Congressional Hispanic Caucus. “Our health care system is geared to take care of really sick people with really, really good and expensive technology,” he added. “What we are not good at is old-fashioned community health. Public health.”
Pandemic as opportunity
The good news is that health officials and policy experts know a lot about how to fix America’s health system. A cottage industry of consultants, advisers and advocates for a health care reboot has churned out volumes upon volumes of white papers, reports and conference proceedings for years. There’s even a fair amount of consensus on the big picture, if not the nitty-gritty. But change is hard, and for every would-be change promoter, there is a change resister, often benefiting from an army of lobbyists or inertia bestowed by the status quo.
So despite the devastation caused by Covid-19, despite the nearly half-million lives lost and the economic and social costs, the pandemic is also an opportunity. The work needed to contain and recover from the coronavirus might — just might — create momentum to fix things before the next catastrophe, which will inevitably come in one form or another, perhaps before we’ve healed from this one.
Any such opening may be fleeting. Americans have short attention spans, so policy makers need to act fast. Governors face many competing demands on their state budgets, some of which were hammered more than others by the pandemic economy. Fixing health is hard — and highly politicized. Some changes can be swift; others will take money and time. But there may not be a better moment to get started.
Joanne Kenen is POLITICO’s executive health care editor
By JOANNE KENEN
02/18/2021
