Public health and health care in the US is in a scandalous state: not news, it has been and has deteriorated over time. Politically active people know this. It hard for me to avoid the conclusion that we care nationally about the economic impact and financial bulk of the ‘healthcare industry‘, but that we have no national interest in public health on any level, policy-wise. If we want affordable and effective medical care for all, it makes no sense to put into the hands of private interests who feel free to prey on the public, not serve them (except to each other, on a bed of rice).
This situation only benefits the mega players, who have reduced medical professions to the status of share croppers, and hospitals into something more like prison farms than infirmaries. We are in this situation because the United States has as a matter of policy rejected the idea that serving public health — and the health of the public — is in any way part of the mandate of government. Instead, we have relied on those who serve the public because they want to; that devotion to service is why doctors have been revered in America — why being a doctor still carries so much weight of respect and deference. Doctors, nurses, midwives earned the place in America’s heart that the medical industry is evicting them from.
What if the US had a commissioned corps — institutionally devoted to public service and public health - whose mission was improving and maintaining public health — a public-health *army* — whose commanding officer was one of the Joint Chiefs of Staff? Taken that seriously?
it sounds like pie in the sky, a “radical leftist restructuring” of Our American Way™...but it isn’t. There IS one: there’s been one since 1798. It currently rots, defunded and unused mostly, and in great disrepair; and it’s commanding general is virtually ignored by everyone.
Meet the United States Public Health Service Corps — whose “primary mission is to the protection, promotion, and advancement of health and safety of the general public”:
en.m.wikipedia.org/…
I encourage everyone to read up on it, but for now, let’s contemplate what a robust, fully-funded, fully-supported, fully-staffed career public-health service would mean to us today.
Like the armed services, it would prioritize preparation and readiness; it would acquire, maintain, and distribute necessary equipment and supplies in times of crisis; it would see to the training, education, and discipline of its members; it would be co-responsible for the CDC and the NIH with the Secretary of Health & Human Services; it would be co-responsible for VA hospitals with the armed services; it would establish at least one free public health clinic in every county in the US, staffed by medical and dispensary personnel; it would make and implement plans for testing, isolation, quarantines, and a health equivalent of martial law during health crises; it would train doctors, nurse, medical & pharmaceutical specialists to the necessary standards and in sufficient numbers — who could repay the nation with a six year term of service.
Really, that’s just the beginning.
If the PHC was held as one of the essential branches of the defense department, the Surgeon-General (yes, this is where the title comes from: it’s an actual *rank*) would sit in panel with the other Joint Chiefs, elevating the influence and arguing on behalf of the public in their deliberations. It wouldn’t be easy, the rise of the Military-Industrial complex and the rise of the Hospital-industrial complex have followed much the same path, and resurrecting the PHC could easily be seen as a funding threat. But if Medicare for All is a possibility, so is this.
With a fully functional public-health service in action, we would have had a handle on COVID-19 by now, the table of organization would include entities that are now as separated as deliberately disruptive policies has been able to arrange. With a fully functional PHC, we might have been able to avoid the privatization and official neglect that has made veterans’ health care and the military retirement system into scandals in their own right.
This is going to require leadership from the bottom. If we want to build on what we have and who we are, then we need to make AOC and Bernie and Elizabeth and JOE (examples close-to-mind, many others, too) know that we found out, push them to support a revitalized public-service Corps, encourage them to work it into the implementation of their healthcare plans, encourage them to elevate the role of the SG In policy-making.
I wasn’t sure where to start, so I made this diary. I hope it starts some discussion. I’m going to learn more, maybe be back on the subject.