One of the clearest lessons of the Covid-19 pandemic is that, for society as a whole to be healthy, everyone needs access to health care.
Untested and untreated people in our community put everyone at risk, and the risk is reduced by universal care. That truth is evident in the no-cost Covid testing and vaccination made available to all, not conditioned on insurance coverage, and by our public health agencies, which were on the front line of the Cape’s coordinated regional response.
But it’s not only this one highly infectious disease that threatens the health of the entire community. The most significant factors in the longevity of any population involve public health issues like potable water, clean air, adequate nutrition, and immunization against infectious diseases. In our relatively privileged part of the world, most of the major chronic risk factors are exposure to toxic substances.
Two local concerns are the widespread contamination of our aquifer by per- and poly-fluoroalkyl substances (PFAS) and the neurotoxic cyanobacteria in Upper Cape ponds from phosphates. Prevention of exposure is difficult, but it avoids the much greater costs of treatment.
Through its focus on preventing illness and disability, public health works to support positive change as well as health monitoring. But it must reach every member of the community and ensure that they can affordably access appropriate care.
Historically, public health services have been provided by the city, county, or state. Barnstable County still has its own tax-funded health department, as does the Commonwealth. The vast majority of health services in the past were publicly funded or provided by charitable or religious groups. These days, personal health care has become a labyrinth of extreme profit centers. Those with means get the best care; those without don’t.
A true health care system would more fully integrate these disparate providers. It would assure the availability to every resident of a full spectrum of preventive care, acute and chronic care, and rehabilitation.
Such systems exist across the developed world. Indeed, they are the norm. Societies have decently and practically determined that health care is a human right and have acted to assure universal affordable access to care.
In the U.S., progress toward an organized health care system has been stymied by the implacable resistance of the medical, pharmaceutical, and insurance industries. Yet such policies enjoy wide public support. Here on the Cape, we saw this clearly expressed in two different votes in 2006. First, a referendum declaring “health care is a human right” was approved by two-to-one votes in the three Cape legislative districts where it was sponsored. And 11 of 14 towns voted for a proposed “Cape Care” community-owned health plan. The plan went to Beacon Hill in 2010, but in the wake of the Great Recession it was dead on arrival.
While a national universal health system makes the most sense, Congress, even in the wake of Covid, would most likely dismiss any such proposal as “socialism.” Here in the Commonwealth, however, a couple of “Medicare for All” bills — one the work of our own Sen. Julian Cyr — are gaining supporters in the legislature. They include dental, vision, and hearing services, as well as mental health and substance misuse treatment. There’s a lot of prevention served up in there.
Originating in Wellfleet, and now across the Cape, a group has come together to support these state efforts toward Medicare for All. We have learned from the legislators working on this that, while support is building, it is not yet sufficient. Gov. Baker, moreover, has made clear his unwillingness to sign. So, this must be a longer-term campaign.
For over a decade, opponents of a universal health care system have promised that the market would be the solution to ballooning costs. Clearly, it is not and it cannot. We are paying the price of that fantasy while we wait for enough decision makers to see the light.
Don’t hold your breath. But do keep your eyes on this one.
Brian O’Malley, M.D., is Provincetown’s elected delegate to the Barnstable County Assembly. Write him at [email protected].