In London 1854, there was a cholera outbreak, and through the detective work of John Snow, it was discovered there was a polluted well, which when closed contained the outbreak. Individuals going to visit the doctor was not going to prevent that spread. Thus, we are in need of proactive, community outreaching program to prevent disease in individuals, prior to then developing illness.
I believe that many people have a rather narrow view of what counts as a medical intervention. The classic narrative is that a person doesn’t feel well, goes to see a physician (or physician assistant, nurse practitioner, etc), gets a workup, diagnosis, and hopefully a treatment or advice. This is quite reactive in nature, does little to prevent illness, and incentivizes people to wait until something is severe and expensive to treat. To some degree society recognizes this and subsidizes some preventative care, like an annual checkup. At that visit, a person can get their vaccines and screening tests. However, this is still a very myopic approach to health.
An article recent published ” estimates the long-run effects of childhood Medicaid eligibility on adult health and economic outcomes using the program’s original introduction (1966–1970) and its mandated coverage of welfare recipients. The design compares cohorts born in different years relative to Medicaid implementation, in states with different preexisting welfare-based eligibility. Early childhood Medicaid eligibility reduces mortality and disability, increases employment, and reduces receipt of disability transfer programs up to 50 years later. Medicaid has saved the government more than its original cost and saved more than 10 million quality adjusted life years.”
What I’m driving at here is that if we get broad and expansive with what counts as a medical intervention and therefore can be covered with a theoretical single payer insurance, then we become incentivized to proactively intervene in places like food as medicine, literacy medicine, exercise as medicine. What holds this back it a misplaced sense of boundaries between what is a medical intervention versus what is a personal choice or responsibility. In Whose Health Is it Anwyays physicians from Imperial College go into detail about the importance of early environment to lifelong health,. If we’re going to be paying for the 65 year old with poorly controlled diabetes on Medicare ANWAYS, doesn’t behoof us intervene as early as possible as comprehensively as possible?