MASS VACCINATION IN A BROKEN PUBLIC HEALTH SYSTEM
By Richard Davis
This country has underfunded public health for decades. We are seeing the results of that malpractice as we try to test and vaccinate a significant number of our population during the COVID 19 pandemic.
It would be simplistic to blame the departed presidential criminal and his team for their lack of action during the pandemic. Yet, they do deserve a good share of blame for not creating a national plan to deal with COVID.
In order to understand why the Biden administration will not find a way to test and vaccinate a critical mass of Americans within a short time frame it is important to know that this country barely has a functioning public health system.
Part of the problem is funding allocation that is dependent on the political process. That means that crisis management is the dominant motivation for action. As a result, the long-term funding needed to manage chronic diseases and to build a solid infrastructure to combat public health threats never seems to be adequate.
Consider this analysis from the Trust for America’s Health, “While the United States spends an estimated $3.6 trillion annually on health, less than 3 percent of that spending is directed toward public health and prevention. Furthermore, public health spending as a proportion of total health spending has been decreasing since 2000 and falling in inflation-adjusted terms since the Great Recession. Health departments across the country are battling 21st-century health threats with 20th century resources. The COVID-19 crisis demonstrates this reality in the starkest of terms.”
State and local health departments rely on a mix of federal and state funding and they do the best with the resources they have. Health professionals are reluctant to work in public health because the pay has historically been lower than most other sectors of the health care delivery system.
In the past 10 years the U.S. public health workforce has decreased by 56,000 positions and surveys indicate that many of those who remain are considering leaving their positions for better pay elsewhere. Our priorities are backwards. Public health institutions should be staffed by the best and the brightest. That is true in many cases and we are lucky to have talented people in critical positions, but the employment trends are troubling.
Why has this country put so little effort into creating a robust public health care system? Politics plays a big part. In addition, we have a health care system in this country that is primarily driven by for-profit institutions such as insurance companies and pharmaceutical manufacturers.
More and more politicians, of all political persuasions, are willing to leave the provision of health care in this country to the whims of market forces. That is considered the American way. But when it comes to health care, market forces do little to assure access and affordability to health care to enough Americans.
The U.S. has the most expensive health care system in the world spending over $10,000 per person per year. Germany spends almost $6000 and Canada spends $5000. According to the Commonwealth Fund, “The U.S. spends more on health care as a share of the economy — nearly twice as much as the average OECD country — yet has the lowest life expectancy and highest suicide rates among the 11 nations. The U.S. has the highest chronic disease burden and an obesity rate that is two times higher than the OECD average. Americans had fewer physician visits than peers in most countries, which may be related to a low supply of physicians in the U.S. Americans use some expensive technologies, such as MRIs, and specialized procedures, such as hip replacements, more often than our peers. The U.S. outperforms its peers in terms of preventive measures — it has the one of the highest rates of breast cancer screening among women ages 50 to 69 and the second-highest rate (after the U.K.) of flu vaccinations among people age 65 and older. Compared to peer nations, the U.S. has among the highest number of hospitalizations from preventable causes and the highest rate of avoidable deaths.”
Although the U.S. outperforms in preventive measures, based on outcomes, it means there is not enough follow-through on those measures and that we over-test and under-treat. In other words we waste a lot of health care dollars only to fatten the bank accounts of for-profit health care entities.
Even with the best of intentions the current plan to vaccinate Americans against COVID 19 will continue to be a logistical nightmare. One would hope that politicians would look at the current abysmal state of our public health system and develop a long-term plan of corrective action.
Instead, they will continue to rely on the private marketplace to provide essential health care services and that means that only profitable strategies will prevail. A successful public health care system relies nearly 100% on government funding and support and we all know how un-American that is.