Personal Health as Public Health

     If an individual becomes sick, does he or she pose a threat to others?  When the sickness is due to transmittable viruses and bacteria, you bet!  Personal health can become public health.
     As discussed in my previous blog posting, the concept of public health in the U.S. dates back to at least the 1640s.  Local and state governments routinely regulate individual behavior that impacts the health of other individuals.  They also provide public health services, such as sanitation, public water, garbage collection, and contagious disease controls.  Public health has always included disease prevention as well as epidemic management. 
     In Jacobson v. Massachusetts, the U.S. Supreme Court ruled in 1905 that states have the power to require individual vaccinations to prevent epidemics (in this instance, smallpox).  The ruling also went far to justify state powers to impose individual isolation and mass quarantines.
     At the national level, the Federal government regulates public health and provides services under the war powers, the taxing powers, and the commerce clause of the Constitution.  The Public Health Service Act of 1944, subsequently amended and enlarged by numerous acts of Congress, created the Public Health Service and the Center for Disease Control (CDC) to prevent the spread of illnesses into the U.S. from abroad and among the states.  Congress further provided health care services to individuals through Social Security and Medicare.
     In 1985, during the Presidency of Ronald Reagan, Congress passed the Consolidated Omnibus Budget Reconciliation Act (COBRA).  Among many provisions, the act prohibited hospitals (but not necessarily physicians) from the practice of “patient dumping” because people could not pay.  Hospitals are required to provide full services in cases of individual health emergencies caused by sicknesses, disabilities, injuries, and assaults regardless of the individual’s ability to pay for such services.  Hospitals often recover their losses by charging other patients and their insurance companies higher prices, so that those who can pay end up indirectly paying for those who cannot.
     If the government requires people to do certain things for their own individual healthiness in the interest of public health and if the government requires hospitals to serve people in medical emergencies, then cannot the government also require patients to pay for such services?  In 2010 Congress passed the Affordable Care Act (ACA), also popularly known as “Obamacare,” mandating that people had to have healthcare insurance to pay hospitals (and physicians) for medical services.  It was a way to balance the obligation to provide medical assistance with the obligation to pay for it.  The constitutionality of Obamacare was twice upheld by the U.S. Supreme Court. 
     The requirement that everybody must have healthcare insurance, including checkups and disease prevention as well as cures and recoveries, is in the public interest.  Requiring individuals to take responsibility for pursuing and paying for their own well-being and healthcare in addition to preventing and managing epidemics is a legitimate government power in the pursuit of public health.  In matters of health, the government is protecting me from you, and maybe you from me.

© 2017 Stephen M. Millett (All rights reserved)