Fixing U.S. Healthcare – Annual Review & Summary 2020

Rudolph Virchow M.D., father of modern pathology and founder of social medicine
Rudolph Virchow M.D. (1821 – 1902), father of modern pathology and founder of social medicine

Like everything else in America in 2020, Fixing U.S. Healthcare blog was touched by the coronavirus pandemicracial reckoning, the election,  and the economic fallout from the other three. 

From its start in 2017, this blog’s stated purpose has been to “[focus] on healthcare cost issues. . . [including] cost-benefit analysis — pioneered in Oregon 25 years ago. . .” and “[to explore] why an even more aggressive approach is now needed at a national level to solve today’s healthcare challenges.” But in this inflexion-point year, this blogger recognized that relentlessly rising costs, while being a veritable thicket of invasive weeds in healthcare’s proverbial forest, are by no means the whole forest.

The Atlantic’s science journalist Ed Yong put it this way in the magazine’s kick-off issue for 2021:

In 1848, the Prussian government sent a young physician named Rudolph Virchow to investigate a typhus epidemic in Upper Silesia.  Virchow didn’t know what caused the devastating disease, but he realized its spread was possible because of malnutrition, hazardous working conditions, crowded housing, poor sanitation, and the inattention of civil servants and aristocrats – problems that require social and political reforms.  “Medicine is a social science,” Virchow said, “and politics is nothing but medicine in larger scale.”

This is especially notable since Virchow is now revered by doctors worldwide as the father of cellular pathology, the use of tissue microscopy to diagnose human disease!

Like Virchow, this blog was sent to diagnose the devastation caused by escalating healthcare costs, and has now reached the same conclusion as Virchow did! The malady cannot be cured by merely tinkering with healthcare finance, nor even by innovating with science and technology – though all of these will be necessary and useful.

No, the coronavirus has made that abundantly clear.  As Yong put it in his September essay, quoted in a previous blog post

Water running along a pavement will readily seep into every crack; so, too, did the unchecked coronavirus seep into every fault line in the modern world.

Those fault lines in America – and in many other countries – run through all the rifts that are now so vividly exposed.  No longer is it enough to say “fellow American.” In 2020, we ask, “What kind of American?”  And the virus invades through the gaps in our solidarity, both literally and metaphorically, into what ails medicine and all of society.

A year ago, I approached my Congressman’s office to promote the ideas in this blog based on implementing cost-benefit analysis. His staffer’s first question was, “Do you consider healthcare a right or a privilege?”

Healthcare Is a Public Good

I now have an answer:  Neither.  It is a public good. Namely, health, healthcare access, and the healthcare system are best understood as a part of the social contract, something to which we all contribute in order to derive a greater collective benefit.

Consider the coronavirus vaccine. The vaccine’s development has been a cooperative effort based on years of basic science research, in turn based on knowledge disseminated through networks of research universities. These universities benefited from free flow of financial capital, intellectual capital, and human capital facilitated by global trust and diplomacy. Venture capitalization was a hybrid of public, non-profit, and private funds. Distribution will now depend on competent civil servants, and in-arm inoculations will be done by organized cadres of professionals, communicating effectively though public channels.

So, in today’s complex society, good government plays an essential role in healthcare. Yes, government should promote market mechanisms when advantageous and appropriate.  And yes, government must be accountable to we-the-people and must be managed by skilled public administrators.  But no, healthcare is too important to be left just to private corporations (especially monopolies) and other powerful special interests.

The same could be said for other public goods in America that have been neglected for too long:  education, infrastructure, climate policy. In fact, only a moment’s reflection will show that all of these 21st century challenges are interwoven with each other and with healthcare.

So, in 2021 we can once again understand Virchow’s insight that “politics is nothing but medicine in larger scale.” 

Is there a doctor in the house?

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Image Credit

Title: Rudolph Virchow

Source: Wellcome Library, London. Wellcome Images Rudolph Carl Virchow (1821-1902) German pathologist and statesman Photograph published 1893


Copyrighted work available under Creative Commons Attribution only license CC BY 4.0

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