The Infrastructure of Health

The American Federal Government has closed. Only essential services are continuing to be delivered. 

Although the rhetoric has shifted, this was started as a fight over Obamacare, and that’s a fight I find frustrating to begin with. I’m in the camp that believes the Affordable Care Act did not go far enough because it is only about health insurance, not health care. It is health care, or at least some elements of health care such as vaccinations, cancer screenings, emergency medical attention, basic maternity and pediatric care which I believe Governments should have a responsibility to provide. Healthcare is not a socialist nose poking itself into everyone’s personal affairs; it is part of the universal infrastructure of society like roads or sewers.  

The health and transport sectors have a lot in common. Both exist on the margins between public service and private enterprise. Both are highly political and require a high level of investment. Both are wide-ranging, diverse fields with plenty of room for individualism, free market enterprise and other buzzwords of capitalist democracy. However, both involve choices and actions the implications of which cannot be contained within individual households or companies. Rather, they, with other services like sanitation and education, form the fabric that connects households and companies. Or, to use the Oxford English Dictionary definition of infrastructure, they are part of ‘the basic physical and organizational structures and facilities… needed for the operation of a society.’ 

Let us consider a company with a supply chain and sales strategy. Does it not require some way of transporting raw materials and employees to its offices and factories and some means by which to distribute its goods or services to customers? Maybe it runs its own trucks and buses, but should it also build its own roads? To where? Customers, employees, suppliers; all have transport requirements. Those requirements change and so do the people a company can call its customers, employees, and suppliers. Even if the company in question is in the business of building roads or running buses, it is reasonable for government to have some oversight of transport infrastructure to support all those independent companies and consumers and choices. 

Likewise, every person is an employee or employer or customer, just as they are a son or daughter, mother or father, and many other roles besides. A certain level of healthcare is required within a certain proportion of the population if society is to have sufficient numbers who can function as employees and employers and customers as well as in their private lives. A certain level of healthcare is required for everyone if society has the goal of promoting the freedom for all employees to change who they work for and all customers who they buy from. This is not actually about life or death. It is about achieving at least enough quality of life for society to function while supporting those individual liberties and free markets. It’s not even about equality, but only its lesser cousin, equality of opportunity, or the something akin to that which is actually achieved. 

Regulations and standards are also characteristics of infrastructure and both the transport and health sectors require them, for the sake of safety at least. People wouldn’t know how to interact on the roads without rules. Buses and trains would never have any customers without an understanding of how, where and when to board them. As for health, how would diseases be controlled without regulated programs for vaccination? How would anyone be able to help someone who through injury had lost the power to communicate without standards for emergency care? What would happen if there was no government dictated number for emergency calls? 

Transport and healthcare are about how individuals and organizations can and do interact. They are the means to, rather than the end goal, which is a healthy, functioning society.  

It’s been two weeks since the government shutdown, and so the list of essential services is increasing because some things that can be done without for a day or two are missed after two weeks. In transport, employees like air traffic controllers and others with responsibility for the safety and operation of the network were deemed essential from the beginning, but only recently have some staff been recalled from the Center for Disease Control and Protection to deal with a salmonella outbreak. This is an unequivocal example of how health is fighting for its place as an essential service.   

Healthcare, like transport, is not only an essential service, but also part of the basic infrastructure of society. Until the American government and the people who elect it realize that ignoring that reality is the disease they are trying to cure, reopening the government will be no more than managing the symptoms.

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