Readers of this blog know the problems of U.S. health care well. Principally, it is absurdly expensive, deeply inequitable, and contributes relatively little to overall public health. Yet, most people aware of these problems have been sidelined, feeling incapable of changing things and left hoping for reform to come from within. But health care providers can feel unable to turn this ship. To make substantial change, it will take those working both inside and outside the system to act up. The health care revolt begins with us.
Inspiration in a department-wide book read
In April 2022, the Department of Public Health at California State University Los Angeles finished a unique, semester-long, department-wide read of the book Health Care Revolt by Dr. Michael Fine. Selected by the faculty, the department distributed copies to more than 500 undergraduate and graduate students. Students read at their own pace, encouraged on by faculty-led classroom discussions. The department coordinated a series of events in support of the read, culminating in a visit from the author.
Several themes of the book–reviewed previously at this blog–drove our discussions:
- The U.S. has a health care market, not a system. A market sells good and services; a system organizes, plans and delivers care where it’s needed.
- Each person in the U.S. forfeits $3000 per year to needless administrative costs and other forms of waste that do nothing to improve health.
- We allow the market to extract money from us, which corporations use to lobby congress to beat back needed reforms, thus weakening democracy.
These ideas are not particularly controversial, but the public does not know them. Upon hearing them, we accept them as the norm because most of us have little or no clear vision of how it could be better. As a result, we do very little as a country to fundamentally fix these problems.
From tinkering to a social movement
We do tinker with reform around the edges. President Biden and Congress, for example, successfully enacted a law to limit surprise medical bills beginning in 2022. Congress is also weighing proposals to cap medication costs for some people. The U.S. has, of course, enacted more substantial reforms, including the Patient Protection and Affordable Care Act. And it has tested ideas like ACOs (Accountable Care Organizations). But these reforms neither delivered truly affordable and equitable health care, nor produced a system.
They do show, however, that change is possible. To build a better health care system, we need to build a social movement around the need for larger reforms. Not unlike the movement for women’s suffrage and civil rights movements of the past, and the current labor union movement that is gaining traction in Starbucks stores and Amazon warehouses, the health care revolt (an effort to fix fundamental problems in the system) will be built over time. It will require millions of us to demand change.
A revolt built on practical steps
Dr. Fine offered our department a host of practical steps to participate in the health care revolt. Here we summarize three of the most relevant for readers of this blog. None of them are easy; all of them require considerable work.
First, we must use our public health and medical care voices. Change begins by sharing the problem and creating a vision of how it could be better. We need to let people know that despite the U.S. spending $4 trillion on health care each year, life expectancy has decreased two years in a row. The public needs to understand that high quality medical care really isn’t available to everyone, but that it should be. We need to compile and share public health data on the health challenges and disparities in each of our communities.
Second, we need to seek leadership training and join the boards of clinics, community health centers, hospitals, and non-profit institutions involved with health care. The students, staff and board of every one of these organizations should represent the community it serves, and make decisions that put their communities first. This must include people who are underserved (including uninsured and undocumented communities) since changes will impact them most. We should publicize the make-up of these boards and encourage people to boycott the organizations that do not act to represent the interests of the community.
Third, we must act together. Clinicians should join or create unions that advocate for better patient care. The California Nurses Association, for, example, which represents over 100,000 nurses, helped bring single-payer legislation to California in 2022, and was extremely vocal when it was defeated. Public health professionals can do so as well, and are well positioned to join forces with many community organizations. Partnerships are crucial in advancing health equity by making it a shared vision and value, fostering multi-sector collaboration, and increasing our collective capacity to achieve the scale of changes we need.
Keep your eye on the prize
Changing the health care system may feel impossible. That is, until we actually change it. Dr. Fine concluded his talk by reminding those of us who join the health care revolt that we must keep our eyes on the prize. The prize is a health care system that is for people, not profit. It is a health care system that provides health care to all Americans equitably. And one that, in doing so, strengthens our democracy. The health care revolt begins with us.
Note: In a follow-up post, we discuss five big questions that we posed to Dr. Fine, along with his answers.
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- Fixing Health Care: A Health Care Revolt Begs Five Big Questions - May 5, 2022
- A Health Care Revolt Begins with Us - April 28, 2022
Ana E. Hernandez