For the security of our citizens and the well-being of our society the argument is being made that we should "defund the police" and transition to a public health approach to community safety.
For similar reasons, why not do the same for our health care system?
The "defund the police" argument goes as follows:
- Too much money is spent on confrontational interventions at the expense of prevention efforts — often doing more harm than good.
- Police officers are tasked with every public safety encounter when social workers or mental health advocates would often be more effective.
- Police traditions and norms are valued over community voices and experiences.
- Racially biased police officers and systems are inadequately protecting and serving Black and Indigenous people and people of color (BIPOC), disrespecting and harming them in the process.
- Police unions are blocking needed reforms and helping their members avoid accountability.
With crime continuing to plague our society, the argument concludes that our law enforcement system is beyond reform and should be defunded, reimagined and restructured.
Unfortunately, similar arguments are also applicable to our health care system:
- Too much money ($3.6 trillion per year) is spent on medical care (less than 3% going to prevention) with many treatments doing more harm than good. Approximately 25% of total health care costs are spent on wasteful activities and about 250,000 deaths per year are due to medical errors, making "iatrogenic" conditions the third leading cause of death.
- Like policing, our health care system is organized around a single type of professional — physicians. This increases costs and limits the ability of non-physicians to provide care at the highest level of their training and abilities.
Midwife-run birth centers, for example, have excellent birth outcomes at lower cost and higher patient satisfaction but are limited by restrictive systems and policies. Advanced practice nurses, community health workers, doulas, nutritionists, social workers, etc., are also systematically underutilized and often actively opposed by the medical establishment, despite solid evidence of their value, especially in underserved communities.
- The focus on physicians reinforces the dominance of expert opinion and science over community needs and experiences.
- Racism is prevalent. Our medical education and medical care systems disadvantage members of BIPOC communities, both as providers and recipients of care. BIPOC professionals are underrepresented in our health care workforce and studies show marked racial differences in the quality of care provided to minoritized communities.
- Although not unionized, physicians have been protected by organized medicine (like the American Medical Association) which has blocked efforts to establish a national health insurance plan and has advanced policy positions that maintain the power and wealth of physicians and limit their liability exposure.
Amid all of this, U.S. health outcomes like life expectancy and infant and maternal mortality are abysmal and are now the worst among high-income countries. Seemingly, the more we invest in our health care system, the less healthy we become.
Our health care system appears to be beyond reform and should be reimagined and restructured. Yet, unlike efforts to reform policing, no one is publicly advocating to "defund the health care system." Why?
Most obvious is that the size and complexity of the health care system makes reforming it a gargantuan task and the failure of previous efforts have dampened people's enthusiasm; not to mention that reform is opposed by powerful vested interests who are financially benefiting from the current system.
But the main reason is that we embrace an inaccurate narrative about health and health care. We consider health to be an individual, not a community, responsibility and consider treatment more important than prevention. We fail to recognize that only about 10% of our health is determined by health care and 30% by individual behavior choices while 60% is determined by community factors — social, economic and environmental conditions.
And, since most health care services are delivered by private entities, we don't feel empowered to hold health care accountable, despite the fact that about 70% of all health care is paid for with public dollars.
We must recognize that health care reform is linked with police reform because both systems help determine the health of a community and both are failing.
The "defund police" movement has demonstrated that when essential community needs are not being adequately addressed, an activated public can change the dominant narrative and force a re-examination of intractable systems.
A "defund the health care system" movement should learn from, and harmonize with, "defund the police" efforts to urgently address the stark deficiencies of two systems that affect the health and well-being of our entire community.
Edward P. Ehlinger, of Minneapolis, is a physician and former commissioner of the Minnesota Department of Health.