Like many of us, my personal feelings and interactions with the US health care system are complicated and often conflicting. Both my mom and I would likely not be alive without the health care we received in times of crisis; my mom for an aggressive cancer and me for a traumatic injury. I am forever indebted to the providers whose care saved our lives.
At the same time, our care came at significant financial cost for my whole family, which we are still navigating all these years later. I’ve also witnessed the direct physical and mental harm the health care system can cause, including when the system failed my sister and father in very painful ways as they were going through health crises of their own. I am still unpacking that medical harm, especially the ways in which the health care system stripped my family members of their humanity. Add to these personal experiences the devastating inequities in outcomes being perpetuated by the health care system on communities of color, with little to no accountability, and my outrage outweighs my gratitude on most days.
Because of these compounding, often conflicting experiences, I feel morally obligated to demand radical accountability and fundamental change in our health care system. I know not everyone feels this way. When I talk about Center for Health Progress’s health care accountability work, people share similarly mixed emotions, but generally stop short of calling for a wholesale redesign of our current system. Polling confirms this, as a majority of Americans have a positive view of medical providers and generally believe the health care system is working for their family. And even though over half of all people in the US now favor Medicare for All, support wanes as people get into the details, such as how their private health insurance would be replaced by public health insurance, yet increases again when people learn they can keep their provider. All of this suggests that people really do want the health care system to change and improve, but they struggle to maintain that resolve when that change might affect the things about the current system that they like and have control over.
These mixed emotions have been heightened during the COVID-19 pandemic. We’ve collectively celebrated the brave and skilled health care workers who are on the front lines fighting this terrible virus. However, we’ve also had to continually reckon with the systemic racism inherent in our health care system, death and case rates that reflect this systemic racism, record profits of health insurers during the pandemic, hospitals laying off hundreds of employees while paying CEOs millions, and our biggest hospitals cashing in on billions of dollars in government aid while safety net clinics and rural hospitals suffer.
The persistent racial health inequities, significant financial harm, and other traumas faced by families in their interactions with the health care system, alongside the shameless pandemic profiteering by some of the biggest players in the system, should be more than enough to spark a mass movement of people calling for change and accountability. But that movement hasn’t materialized in real terms yet. What will it take? For one, we need to practice both/and thinking. We can allow ourselves to BOTH honor the many great individuals and organizations inside our current health care system who save lives and care deeply about their patients AND demand a new system that prioritizes people over profits, tackles systemic racism head on, and invests in things that actually create health.
More than anything though, we need to find tangible ways to wrest the immense political and financial power away from the current actors in the health care system who will always preserve their self-interest and multiply their power, no matter the cost. As Frederick Douglass declared over 160 years ago, power concedes nothing without a demand. Our demands cannot be isolated, or one-off. We need a large, national movement of people power that makes coordinated, clear, bold demands of the entrenched power of our current health care system.
Let this movement be both a celebration of the heroes and heroics of US health care, and a constant reimagining of a new system that prioritizes human wellness and dignity over all else. The realization of this movement will depend on our ability to hold both of these as true and necessary at the same time. Are we up for the task?