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If you’re like most of us, you probably haven’t spent a whole lot of time thinking about the public health system. It’s usually just one of those things that most people don’t pay a lot of attention to, at least not until you need it.

But if the COVID-19 pandemic has taught us anything, it’s the crucial role of public health systems in modern societies. Nevertheless, the formation of public health systems never comes easily. That’s especially true when it comes down to the question of universal healthcare.


Systems of public health and the debate over the issue of universal care have been evolving for hundreds of years. And from the Enlightenment onward, public health has been strongly linked to our modern understanding of freedom, liberty, and human rights. But where did it all begin, and how?

Healthcare in the 18th Century

Health is perhaps the greatest gift, and the biggest worry, of human life. But, for the bulk of human history, our understanding of health and medicine has been pretty darn primitive.


By the 18th century, though, we were truly beginning to develop the foundation for modern medicine, and for modern public health, as we know them today. A growing understanding of infectious diseases led to the establishment of quarantine and infection containment policies in major US cities, such as Boston and Philadelphia. At the same time, general hospitals and mental institutions were being established for the treatment of the physically and mentally ill. 


Likewise, in 1796, English physician Edward Jenner administered the first known vaccine against infectious disease and, in the process, laid the cornerstone for the development of modern epidemiology.


Less than 50 years later, the American Medical Association (AMA) would be formed. The AMA was created, in part, to establish codes of ethical conduct and procedural best practices among healthcare providers and institutions in the newly-independent nation. And, just like that, America’s public health system began to emerge in earnest.

A Universal Right?

The modernization of medicine and the evolution of public health systems have gone hand-in-hand across the last three centuries. Nevertheless, that doesn’t mean that there has been such widespread agreement on the issue of universal healthcare.


Across much of Europe, the fight for some form of universal healthcare has been largely won. In Germany and Britain, for example, universal care has held something of a paradoxical position, being upheld as a bulwark against socialism rather than a manifestation of it. It’s seen as injecting a bit of heart in liberal governments based in free-market competition.


But the US has so far not been able to strike such a compromise between universal care and individual freedom. For more than 150 years, legislators, healthcare providers, and citizens alike have tangled over the question of just how large a role the government should play in people’s medical care.


And after so many centuries, pretty much the closest the US has come is the Medicare system, offering free and low-cost health coverage to seniors and persons with disabilities. The Medicare system also allows participants to share in savings plans to help them reduce or even defray the costs of preventative and therapeutic care.


Nevertheless, the coronavirus pandemic has revealed devastating lapses in the American public health system today. These disparities have shown that as powerful as the system may be, the dream of universal care in America remains elusive.


Studies show, for instance, that Americans routinely avoid or delay essential healthcare, from primary care to dental and vision care. More than 44% of Americans, for example, report that the high cost of healthcare has caused them to skip medical appointments.


In recent years, however, the idea of establishing a “public option” for the US healthcare system has been gaining traction. And, in the wake of COVID, this trend has only accelerated.


The public option, supporters claim, will move the US system a step toward universal care, helping to protect and serve those who today fall too easily through the cracks of the healthcare system. At the same time, the public option is designed to protect the freedom of choice and preserve the high quality of private care so long privileged in the American system. 

The Takeaway

Modern public healthcare systems have perhaps done more than any other modern evolution to increase the human lifespan and improve the overall quality of those long lives. As important as public health systems are, as central as they may be to the functioning of modern societies, they haven’t always met with unanimous agreement. The question of universal healthcare in the United States remains particularly vexed. For more than 150 years, Americans have struggled to find the balance between individual liberty and universal care.


About the Author:
Frankie Wallace contributes to a wide variety of blogs and writes about many different topics, including politics and the environment. Wallace currently resides in Boise, Idaho and is a recent graduate of the University of Montana.