July 1, 2009
PUBLIC HEALTH: NOT AN OPTION, A NECESITY
The three most important questions for healthcare reform are:
- Who wants what?
- Who gets what?
- Who pays for it?
National healthcare reform requires that we answer these questions, once and for all. Squabbles over contentious issues such as whether there should be a "public option" distract, divert and destroy the fleeting opportunity for universal healthcare that is now within our grasp – and will not be graspable again for many years to come.
In the same way that Barack Obama focused his entire campaign around a single word, CHANGE, I propose that we now focus the national conversation around a single phrase, PUBLIC HEALTH. That is, "How shall we provide for the public health?" In this moment of pandemic Swine Flu the phrase, PUBLIC HEALTH, and the reform of healthcare around this phrase, could not be more apropos.
Surely, we will need to create a list of priorities against which available funds will be matched. As an example, all children should be immunized. All pregnant women should receive prenatal care. All adults who would like to participate in a smoking-cessation program should be able to do so. (Barack sign up!) All adults should be screened for colon, prostate, and breast cancer on a regular basis. Etc, etc, etc, …. until we run out of the money set aside for our PUBLIC HEALTH. The budget for PUBLIC HEALTH could then be revisited on a regular basis so that feedback loops and adaptation to a changing environment can emerge as needed.
Furthermore, overly expensive end-of-life treatments that provide no survival benefit must be abandoned. Evidence-based medicine and outcomes data must take a prominent role in designing PUBLIC HEALTH priorities and goals.
This proposal to match priorities to budgets would allow individual states to have maximum involvement in how PUBLIC HEALTH would be implemented locally. Rural communities, suburban communities and urban communities would all be able to tailor priorities to resources in a sensible and fiscally responsible way. Everyone would understand this process! It would not be easy, but it would be fair.
Set the list of priorities. Set the budget. Then proceed with the challenge of making these two match as far as possible. For those items that might not make the "final cut" but that are highly desirable, (e.g., breast reconstruction following mastectomy for breast cancer), private insurance may be purchased or provided by employers. Let the private insurers compete among themselves for non-public healthcare. They call themselves capitalists: let them compete, in the private sector, for a service that is private, not a service that is public.
PUBLIC HEALTH should be thought of the same way we think about our other public services like fire, police, and primary and secondary education. PUBLIC HEALTH is not private healthcare: It is different, and it is necessary. And is should be, and must be, universal.
This brief outline for PUBLIC HEALTH is not complete or perfect. There is no such beast. But it contains the one key ingredient for national healthcare reform, the concept of PUBLIC HEALTH.
Regards,
Kathleen T. Ruddy, MD
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