Healthcare as a Common Good
Sam Kahl and Suzanne LaGrande
Every day, we get a new report and watch the upward curve — the number of new cases and those who have died from Covid-19 both in the U.S. and worldwide.
What the Statistics Don’t Tell Us
The statistics tells us how many people have died, but not necessarily the reasons why.
The statistics don’t account for or separate out the percentage of medical personnel — doctors, nurses, health providers, first responders — who died because they were not provided with the personal protective equipment — masks and gowns and gloves needed to remain safe while treating their patients.
The statistics don’t reveal the percentage of patients who died because hospitals lacked needed medical equipment — respirators and even hospital beds to treat patients who might otherwise have survived.
Clearly, the US hospital system was unprepared for a wide scale disaster like a pandemic.
What may not be clear is that this lack of preparation, and the shortages that are costing lives and contributing to the steep curve, were deliberately planned. To understand the reasons why U.S. hospitals are unprepared, we need to look to the history of how hospital infrastructures were built.
1946–1970: Creating a National Hospital Infrastructure
After The Great Depression and WWII, most U.S. citizens and even those in the business community looked to the federal government to provide services such as national highways, the post office, and public schools for the public good of all citizens. Public health fit right into this outlook.
Coming out of the economic and wartime mobilization of 1930s-40s, readiness was deemed the common good. In this political climate, the 79th United States Congress passed the Hospital Survey of 1946. Sponsored by Senator Harold Burton of Ohio and Senator Lister Hill of Alabama, the law became popularly known as the Hill-Burton Act. The goal of the bill was to create modern medical facilities in every American county with a standard of 4.5 hospital beds for each 1,000 people.
Several factors came into play in this planning and calculation:
· The projected needs of patients with tuberculosis, mental illness, and chronic disease.
· The general population as a whole and the distribution of the population.
· The capacity of medical science, as of mid-century, to provide treatment.
· What kind of bed use this would mean.
· Projections of care medical science anticipated the US might need in the future.
The ratios were devised on the basis of a needs — not for-profit — analysis.
In 1946, the physical infrastructure facilities did not yet exist. A nationwide building project was commissioned that lasted from the passage of the bill in 1946 to attainment of the bill’s goal by 1970s. During this forty year period, it didn’t matter that some of the beds remained unused for periods of time. Like a peacetime military, research labs, or a stockpile of foods, these beds were earmarked for future contingencies.
1970s–1990s: Demise of the Common Good — Rise of Privatization
In 1997 direct community-based federal healthcare construction financing came to an end. Having unused beds available for contingencies was not profitable, so the unused beds were perceived as wasteful and liabilities. The primary goal of hospitals was no longer to serve a common good, but to make a profit.
Not coincidentally, in 1999 Congress replaced an operational commercial banking-for-economic-investment with conglomerate banking-for-portfolio-profit under the Gramm-Leach-Bliley Act. This system of for-profit banking fit into the new social scheme of maximizing profit from every corner possible: postal service, K-12 education, higher education, prisons, pensions and health providers.
After 1997 about 140 healthcare facilities nationwide operated under a Hill-Burton mandate to provide free or reduced-cost care. Some Hill-Burton clinics and hospitals still exist around the country, specifically financed by a part of the law intended to provide care to those unable to afford it. However, in general, instead of seeing health care as a common public good, today healthcare is seen as a pay-for-service institution, determined by free market economics.
Healthcare in the US is now driven by market values. Hospitals and medical clinics are businesses, which means they must make a profit. Having reserves of beds, or planning for the needs of the public are weighed against the bottom line, and we are seeing the results of these market-based calculations.
The Common Good
This sort of endeavor is outside the capacity and thinking of market economics. Market is an agency of trade. Whether as goods, ownership of wealth, or titles based on titles to wealth, the private advancement of traders (as merchant and consumer) is the object.
Common — or public — good is engendered in the life of society. Common good makes an unmistakable appearance when joining us together to anticipate or meet natural disasters, pandemics, and hostile powers. The same means can be more positively employed to reach beyond ourselves, as in reaching into a Moon-Mars project.
Today, as medical care workers and patients in the U.S. are dying, it’s time we revisit the decision to view hospitals and hospital infrastructures as private assets, rather than as a public good.
The Covid-19 pandemic shows us why we need a vision of the public good.
Free market economics did not anticipate, nor can they address the needs of the public in a situation of a natural disaster or pandemic.
We are experiencing a reckoning of the affairs of our government. It is also a reckoning of the values we as a society have committed to in terms of our economy, our government, our healthcare, and ultimately the value we place on human life.
