Click here to download this article as it appears in the magazine, with accompanying artwork.
This article is from the Winter 2021 issue of the Nonprofit Quarterly, “We Thrive: Health for Justice, Justice for Health.”
What might healthcare look like if the profit motive were removed from the provision of care altogether? If healthcare were designed as a public service, what possibilities would exist for health equity, health system resilience, and reduced costs? The multiple crises of our current healthcare sector, laid bare by COVID-19, should move us to ask deeper questions about how our investments into the healthcare sector should be employed to maximize the health and well-being of our people and economy.
There are, sadly, few bright spots in a system that has allowed more than one in five hundred Americans to die due to COVID-19.1 Many readers may be surprised to learn that one of the few highlights in healthcare performance during the pandemic comes not from the nation’s richest hospital systems or biggest names in medicine but from the poorly understood and often maligned Veterans Health Administration (VHA).
The VHA—the country’s only fully public, integrated healthcare system—has a lot to tell us about how a national healthcare service for the United States might operate, and not just for its performance amid COVID-19. Indeed, combined with other public healthcare institutions, it could prove to be a critical institution to achieving health justice.
While the new is often fetishized, sometimes the most effective and feasible models are not new; they just need dusting off so that we can see them for what they are. Healthcare as a public service is one such model, and the VHA could help jump-start a revival of this model today.
U.S. Healthcare in Crisis
The COVID-19 pandemic has brutally exposed the weaknesses of the nation’s fragmented, inequitable, and extraordinarily expensive healthcare system. In the early days of the pandemic, as revenue from elective procedures cratered, many health systems furloughed staff, cut their hours, or reduced pay, even as demand for emergency care due to COVID-19 exploded. Many hospitals resorted to rationing care, and some shuttered altogether. Increasingly, we are witnessing the collapse of U.S. healthcare, as multiple crises—including lack of rural hospitals, shortages of physicians, and overpriced treatments—collide.2
Hard though it may be to believe, today healthcare consumes almost one fifth of the entire