What if we could all see the corpsman?

 Atul Gawande has an important article in the Aug. 30 issue of The New Yorker: “Costa Ricans Live Longer Than Us. What’s the Secret?”

Here’s the nut graf, as they say in the newspaper business:

“Although Costa Rica’s per-capita income is a sixth that of the United States — and its per-capita health-care costs are a fraction of ours — life expectancy there is approaching eighty-one years. In the United States, life expectancy peaked at just under seventy-nine years, in 2014, and has declined since.”

In 1950, average life expectancy was 55 in Costa Rica and 68 in the United States.
What happened?

Gupta’s article suggests that Costa Rica simply put public health first. That is, the public health system got priority. Public health officials set the goals for the country’s health-care system as whole. In Costa Rica, everyone is entered into the public health system, meaning each individual’s basic records are there. The county set up teams that include a doctor, a nurse and a health-care technician that visits each household at least once a year.

Despite the poverty in Costa Rica, fewer people die of preventable disease.

In reading the article, I was reminded of the public health system I enjoyed during my misspent teenage years, under supervision of the U.S. Navy.

The Navy did not like sailors missing work. If you were sick enough to miss a watch, you saw a technician called a hospital corpsman immediately. He or she would treat you and get you back on duty within minutes. If you were really sick, you might be passed up the line to a chief corpsman, who had more training, more credentials.

Of course the Navy had primary care physicians and specialists. But you didn’t start out with the specialist. And you didn’t wait for an appointment. And you did not have lengthy discussions about what vaccinations you were willing to take.

The Navy had an intense interest in public health: getting its workforce working at minimal cost.

We Americans have known better for decades.

We talk about helping the sick on Sundays. But we vote for politicians who constantly undermine confidence in the concept of public help. We vote for scoundrels who protect investment in the existing health care system, even though it isn’t all that good at preventing people from dying of entirely preventable diseases.