from 1776 to 2020-a vision for a “more perfect Union”

The United States’ healthcare system combines public health efforts with mostly private delivery of health care. Usually they coexist side by side with some but infrequent interaction. The public health emergency created by the pandemic forced them into a “union” that quickly became politicized, and unfortunately diminished the effectiveness of the response.

Declaration of Independence and the American flag

In ophthalmology, visual acuity is measured by the distance one can see compared to “normal”. A person with 20/80 vision can see at 20 feet what a normal vision person can see from 80 feet. Perfect vision is labeled 20/20.

Maybe you expected 2020 to be a perfect year. I doubt that any of us would say it was. The year brought

  • a contentious presidential election and an unexpected serious pandemic
  • peaceful protests and raucous riots
  • racism confrontations and reconciliation pursuits
  • health inequities battles and healthy community pursuits

This next year 2021 has already had its share of problems, but I think most of us feel calmer, more hopeful, and eager to resume many of the activites we put on hold last year. And that includes a 4th of July celebration.

Statue of Liberty
Lady Liberty lifting her torch in New York harbor
Independence Day, July 4

Every year on July 4th the United States celebrates Independence Day- the day in 1776 the original 13 American colonies established an independent country.

A few years later they established a government as specified in the Constitution of the United States, to “form a more perfect Union”.

The United States Constitution

The Constitution does not specifically mention, establish, create, or endorse a healthcare system. Some phrases in the Preamble hint at it though-

  • establish Justice
  • insure domestic Tranquility
  • provide for the common Defense
  • promote the general Welfare

Government sponsored health care programs

The Affordable Care Act, aka Obamacare

The  United States Congress passed the Patient Protection and Affordable Care Act (ACA) in 2010 to guarantee basic health insurance to all citizens.  During his term in office, President Trump vowed to “repeal and replace” this law but although it has been modified, it is still in place.

Healthcare for military service members, veterans ,and their families

During the American Revolution the fledgling government extended health care benefits to the soldiers and veterans of that war; that system evolved into the current Department of Defense military health care system which covers service members and the Veterans’ Administration system for veterans.

a Veterans Administration clinic
a Veterans Administration clinic (photo by Dr. Aletha)
American soldiers serving in Afghanistan
American soldiers serving in Afghanistan
Medicare and Medicaid

Two other government healthcare programs- Medicare and Medicaid are over 50 years old. 

Medicaid provides insurance coverage for adults and children who are unemployed or low income.  

Medicare covers disabled children and adults  and persons 65 years and older.

a senior adult couple relaxing in lawn chairs
by Brayden Heath from LIGHTSTOCK.COM

Department of Health and Human Services

Most of the health care activities of the federal government fall under the agencies of the Department of Health and Human Services or HHS. The Secretary of HHS serves in the President’s Cabinet.

Due to the COVID-19 pandemic, we’ve heard more about the HHS in the news than usual; maybe you’ve never heard of these agencies. Generally, management of a pandemic or other public health emergency falls within the work of the CDC.

Centers for Disease Control and Prevention

The CDC’s mission is simple but encompasses many facets of health

“to work 24/7 to protect America from health, safety and security threats, both foreign and in the U.S.”

The CDC website devotes an entire section now to information, guidelines, and news about the SARS-CoV-2 virus and COVID-19.

illustration showing the coronavirus which causes COVID-19

The goal of public health is to avoid or prevent health threats from becoming public health emergencies, like the COVID-19 pandemic. If they accomplish the mission, we hardly notice. But when an outbreak occurs, their work suddenly becomes visible, scrutinized, and debated.

The CDC director, Dr. Robert Redfield, spoke to Congress soon after the pandemic started, and his assessment of the response and funding for it were not positive. Lack of funding hampered the federal government’s response to the coronavirus outbreak, he told lawmakers on March 10, 2020.

“The truth is we’ve underinvested in the public health labs,There’s not enough equipment, there’s not enough people, there’s not enough internal capacity, there’s no search capacity”

Dr. Robert Redfield, Director, CDC

The Trump administration subsequently enlisted private companies to help cut the difference. The CDC partnered with Integrated DNA Technologies to manufacture the COVID tests under a CDC contract. IDT partnered with commercial labs for the testing.

2021-the Biden Administration

On December 7, 2020 President Biden’s transition team announced that Rochelle P. Walensky, M.D.  was slated to become the new director of the Centers for Disease Control and Prevention. In a 2021 interview she talked about the “big questions that keep her up at night.”

  • How are we going to ensure that the people who are hardest to reach with COVID vaccines receive it?
  • How are we going to ensure that when everyone else is not thinking about COVID we are still leveraging the infrastructure and connections we’ve made and that we address the collateral damage of this pandemic: the hypertension , the pediatric vaccinations that haven’t happened, HIV control?
  • How are we going to address a resurgent opioid crisis that I thought I’d never see again?
  • How are we going to address gun injury prevention?
  • How do we not only protect this nation, as we realize that we need to protect the world, too. Not just for humanitarian purposes, but because we are so integrally linked, as this virus has taught us.

National Institutes of HealthNIH

The National Institutes of Health, part of the Public Health Service,

  • supports biomedical and behavioral research with the United States and abroad,
  • conducts research in its own laboratories and clinics,
  • trains promising young researchers, and
  • promotes collecting and sharing medical knowledge.

And within the NIH is the NIAID– the National Institutes of Allergy and Infectious Diseases, which has been an invaluable source of guidance as the United States and the world works to understand and manage this new infectious disease.

President Donald Trump Visits NIH
President Donald Trump visited NIH on March 3, 2020 and toured the National Institute of Allergy and Infectious Diseases’ Vaccine Research Center (VRC) to learn about research on a vaccine for the novel coronavirus SARS-CoV-2. From left: VRC Deputy Director Dr. Barney Graham, NIH Director Dr. Francis Collins, VRC Director John Mascola, Department of Health and Human Services Secretary Alex Azar, President Trump, and VRC Research Fellow Dr. Kizzmekia Corbett.
credit NIH, public domain
Novel Coronavirus SARS-CoV-2
This scanning electron microscope image shows SARS-CoV-2 (orange)—also known as 2019-nCoV, the virus that causes COVID-19—isolated from a patient in the U.S., emerging from the surface of cells (green) cultured in the lab.
 
Credit: National Institute of Allergy and Infectious Diseases-Rocky Mountain Laboratories, NIH
President Biden Visits NIH Vaccine Research Center
NIH immunologist Dr. Kizzmekia Corbett speaks to President Joe Biden about the fundamental research that contributed to the development of the Moderna and Pfizer COVID-19 vaccines when the President visited NIH’s Vaccine Research Center on February 11, 2021. Credit: NIH/Chiachi Chang

Food and Drug Administration– FDA

The FDA joins the pandemic response by

  • reviewing and approving diagnostic tests for the coronavirus
  • protecting consumers from fraudulent products for COVID-19.
  • issuing Emergency Use Authorizations (EUAs) for ventilators
  • sampling and testing of respirators for importation

Late in 2020 the FDA gave Emergency Use Authorization to 2 vaccines against COVID-19. By December Americans began receiving “shots in arms”, a welcome step in returning to normal.

COVID-19 Diagnostic Test Attire
FDA Commissioned Corps officer RADM Estella Jones, DVM, OCET Deputy Director and Co-Chair of the FDA Animal Welfare Council, oversees Commissioned Corps officers as they practice proper fitting of protective items. Healthcare workers testing patients for COVID-19 novel coronavirus infection must wear specific protective gowns, gloves, ventilation masks, and full facial shields as shown, and must replace these items after each patient is tested. credit FDA, public domain

Occupational Safety and Health administration-OSHA

OSHA is part of the United States Department of Labor. OSHA’s administrator answers to the Secretary of Labor, who is a member of the cabinet of the President of the United States.

Congress created the Occupational Safety and Health Administration (OSHA) in 1970 to

ensure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance.

For the pandemic response, OSHA offers guidance on

  • returning to work
  • preparing workplaces for COVID-19
  • worker exposure risk to COVID-19
  • for specific industries including airlines, farms, retail, corrections
  • use of respiratory protection equipment

important laws that administer and regulate both private and public healthcare.

The Affordable Care Act- ACA
Health Insurance Portability and Accountability Act-HIPPA
Emergency Medical Treatment and Labor Act- EMTALA
Americans with Disabilities Act-ADA
Family Medical Leave Act-FMLA
replica of the Liberty Bell at Disney World, Florida, photo by Dr. Aletha

Let Freedom Ring

In the Declaration of Independence, the founders of the United States created a nation based on the “self-evident truths”  of  “Life ,Liberty, and the pursuit of Happiness” and to promote “Safety and Happiness” . 

They didn’t mention “healthcare” either, maybe because in the late 1700s medical practice was more superstition than science.

Surgery was rudimentary due to no anesthesia and infections frequently proved deadly due to no antibiotics.

No one had even imagined, much less identified the human genome, and viral DNA-what was that??

I wonder if they intended their new government to spend so much time and money providing and regulating health care –most of which was not available or even imagined at that time? 

Public vs Private-not a perfect Union

The United States’ healthcare system combines public health efforts with mostly private delivery of health care. Usually they coexist side by side with some but infrequent interaction.

The public health emergency created by the pandemic forced them into a “union” that quickly became politicized, and unfortunately diminished the effectiveness of the response.

But despite the lack of coordination and cooperation between all levels of government and private citizens, our health care professionals, in both public health and private medical practice stayed true to their calling. Many risked their own lives to care for COVID-19 victims. Others sacrificed time and finances to lead the pandemic response in their communities and on social media- maybe not perfectly, but definitely UNITED in resolve to lead, help, and heal their fellow citizens through this unprecedented health emergency.

Let’s celebrate!

woman holding a sprakler
Let’s celebrate ! This photo and featured image from stock photo site- Lightstock.com (affiliate)

Sharing and celebrating the HEART of life, liberty, and the pursuit of HEALTH and happiness

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .

Dr. Aletha 

a woman in a red, white, and blue shirt
Me, a few years ago, showing my patriotic spirit by posing in red, white, and blue

Author: Aletha Cress Oglesby, M.D.

I am a family physician who explores the HEART of HEALTH in my work, recreation, and through writing. On my blog, Watercress Words, I inform and inspire us in healthy living. I believe we can turn our health challenges into healthy opportunities. When we do, we can share the HEART of health with our families, communities, and the world. Come explore and share with me.

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