THE PATIENT IS READY
Thanks to the ravages of
COVID-19, Americans are
more attuned to health
and the nation’s health
system than they’ve been
for at least a century. This
presents an opportunity
to repair and expand
Obamacare and, perhaps,
rescue the nation’s broken
public health system.
Clockwise from right:
Representative Rosa
DeLauro of Connecticut;
Obamacare supporters
celebrate a Supreme Court
decision to uphold the law
in 2012; President Obama
signs the Affordable
Health Care in 2 010.28 NEWSWEEK.COM
PUBLIC HEALTHthe only major healthcare organization in America
that does better financially when it keeps patients
healthy, which creates a powerful incentive to stay
in close contact with patients, to get them into
programs to help them overcome unhealthy hab-
its, and to be aggressive about treating problems
when they first emerge. Perhaps as a result, stud-
ies have shown that VA patients tend to get better
healthcare than other U.S. patients, are typically
more satisfied with their care, and incur costs that
average about 10 percent lower.
Almost everywhere else in the developed world,
preventive health is supported by strong prima-
ry-care systems that most people have regular access
to and that promote healthy habits such as quitting
smoking, losing excess weight and staying physically
active; they also look to nip potential health prob-
lems in the bud when they’re easier to treat. In the
U.S., primary-care visits are irregular, often perfunc-
tory and simply neglected altogether by a big swath
of the public to save the expense of doctor’s visits
and tests. In 2018, the CDC found, 50 million Amer-
icans didn’t see any healthcare professional at all.
As a result, the U.S. is beset by a virtual epidemic
of preventable hospitalizations and deaths from
chronic disease. “Primary care is the poor relation
of healthcare in America,” says Tom Frieden, former
director of the CDC in the Obama administration
and now CEO of the non-profit preventive-health
initiative Resolve to Save Lives. “We can’t even get
the most important things right in health, like
controlling blood pressure, limiting sodium, and
reducing tobacco addiction.” As long as no one pays
healthcare systems for pushing those measures, im-
provements are unlikely.
The neglect of preventive medicine isn’t the
only problem. Another big cause of unusually high
rates of disease, with their resulting horrific costs
and death rates, is the nation’s miserable record in
addressing what experts call the “social determi-
nants of health”—meaning the links between poor
health and poverty, inadequate housing and lack
of access to good education, nutrition and other
basic resources. These links have now been firmly
established by numerous studies and have become
a maxim in public-health circles.
To take one recent pre-pandemic study, an
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