One hundred years ago we implemented universal, mandatory primary and secondary education. In many ways, that is the model we need to use to build public healthcare.
For decades, Americans have been debating healthcare at the national level. Our current partisan stalemate means we still have no public healthcare. However we do not need to accept this partisan stalemate as defeat. The national debate rests on the assumption that public healthcare must be enacted at the national level, as one policy. That is not how universal public education was implemented. Public schools started at the local and state level, and only became universal because of a sustained popular movement.
Healthcare systems are also run, largely, at the local level. Reaction to the coronavirus outbreak shows a great example of how this can work. The Bay Area is a Pacific Rim metropolis, so we were worried about the coronavirus a little earlier than other parts of the country. The first large-area lockdown was requested by the health-department directors of the Bay Area counties on March 16, 2020. Then the state of California followed suit. We did not need to wait for direction from the federal government. In practice, we implemented health policy first at the metropolitan level. As of March 26, the federal government is still sending conflicting messages, including a suggestion that we get back to work after only a two-week self-quarantine.
This outbreak also shows why we need a public healthcare system. We should not be trying to figure out the medical-insurance status of someone who needs to be put on a ventilator, let alone their citizenship status. A person with severe COVID-19 symptoms is in imminent danger of death, and is also a serious contagion threat. For both reasons they need immediate care and isolation from the population. Once under care, there is time for questions; but questions they need to be about contact history, travel history, and prior medical conditions of the patient, not about which insurance policy covers them or what deductible they have.
As for bureaucracy? Somehow we keep missing the elephant in the room: insurance companies are private, and yet they generate reams of paperwork. The thick “health care benefits” packets we get from insurers include a lot of fine print about what they do not cover. Their bureaucratic, excessive-busywork practices are part of their profit model. If bureaucracy is profitable, then private-sector bureaucracy can and does greatly exceed public bureaucracy. Use your own evidence: recall the paperwork-hassles you have had with a private medical insurer, compared to the paperwork-hassles you have had getting your child into a public school. Public school operations and regulations are actually extremely complex, but for the vast majority of parents and their children the process of enrollment is incredibly easy.
We now assume that free, public education from K through 12 is both a right and an obligation. But that did not exist 120 years ago. No one is alive to remember that fundamental shift in public expectations and policy change. Nor is there any Constitutional Amendment declaring universal national K-12 public education. It built up locally, by popular demand.
Public education does provide one cautionary tale: unequal implementation. Because it grew from local roots (and pre-dated income tax), education was funded locally. Unfortunately that means per-student school funding corresponds to the relative wealth or poverty of each jurisdiction. As we build our public healthcare system, we need to maintain equitable funding at every step of the way. That means adjusting the sources of taxation in order to maintain equitable funding, if necessary. One under-funded healthcare district can be a source of accelerated contagion for us all. We literally cannot afford that risk.
Funding public healthcare will require policy changes, yes. But clearly, we need a more robust emergency-response infrastructure as a standing asset. We also need more continuous health-maintenance, and we have plenty of data to show the robust economic payback for maintaining a healthier working population. This parallels public education: a massive, tax-funded, labor-intensive process of teaching literacy, numeracy, and critical thinking to the entire American public since 1910. The result? Unparalleled economic growth, innovation, and improvement of everyday life. There is no question that public education is a huge expense, and there is no question that it has been very worthwhile.
This crisis is a decision-point where we can choose to go in very different future directions. It is not just an economic downturn; it is a shock that will permanently alter our political economy. We should not wait for national leadership to respond to this. We do not need to wait for top-down policies to start this shift. It began with county health-directors in the San Francisco Bay Area. We can begin to make a public healthcare system at the county and regional level. Successful practices will not only shift expectations and demands on governors, but also provide models for how to actually do it.
Call your local representatives now. Public healthcare is a right, and we need it now.