“The health of the people is really the foundation upon which all their happiness and all their powers as a state depend.” -- Benjamin Disraeli

Public health can seem dry and esoteric. It is not.

Public health is all about who lives and who dies. It’s about how well, how vigorously, and how long we live. It’s about how soon and how miserably (or peacefully) we die. And, as Disraeli articulated, all of our powers as a nation depend fundamentally on the health of the people.

Few things are more important than our nation’s public health, and I cannot name any of them.

Which is why I am simply over the moon about the American Rescue Plan: it is a rescue of public health in America.

Nerd out with me for a moment, if you will.

The 1.9 trillion-dollar American Rescue Plan (ARP) is gargantuan, and its size precisely matches the existential scale of the most desperate public health crisis in over a century. It is exactly what is needed, this moment, for the health of our people and the powers of our nation.

Life expectancy in the United States decreased by a full year during just the first six months of 2020; the data are not yet complete for the latter half of 2020, but the vast majority of deaths from COVID-19 occurred in the latter half of that annus horribilis, and it’s likely our life expectancy decreased by about four or five years due to the pandemic. (The U.S. had 108,600 dead by end of June 2020, 354,000 by year’s end, and 536,000 dead as of March 16. We are losing about 1,250 lives per day (currently dropping). Millions more Americans risk lifelong morbidity and premature mortality from sequelae of COVID-19; we don’t yet have any idea how bad this will be.

The United States has experienced only two drops in life expectancy since 1860: during the bloody final months of the Civil War, and during the 1918 influenza pandemic. Otherwise, we have seen a steady increase in life expectancy. At our current rate of loss, though, we may wind up losing all the progress we have made since about 1980.

To change that trajectory, the American Rescue Plan is key.

The plan puts more shots in arms, more vaccines in the pipeline, dollars in the pockets of Americans, kids in school safely, better medical insurance, and more. Every one of these is critical to public health, both for the short term, and for the long haul.

The American Rescue Plan moves:

  • shots into arms: The devastation will not end until the virus is defeated. Every dollar buys survival. The ARP pays for hundreds of millions of additional doses, and sets up distribution and vaccination for fast, efficient and equitable immunizations.
  • dollars into pockets: Poor people lose as much as 14 years of life, compared with the wealthy. The ARP provides $1400 to 85% of Americans. Funds were going out even during the Rose Garden signing ceremony!
  • millions of families out of poverty, reducing food and housing insecurity, alcohol and substance abuse, domestic violence, suicide and other deaths of despair.
  • kids into schools, with ventilation and barrier improvements, PPP, hygienic measures, and more; and tens of billions of dollars for struggling colleges and universities. Daycare is likewise protected.
  • millions of kids out of poverty, cutting childhood poverty by about half. Every year a child spends in poverty reduces lifetime income by about $54,000, with all the increased morbidity, mortality, and other suffering that lifelong poverty brings. The ARP pays most families $3,000 for each child ages 6 to 17, and $3,600 each for younger children. This will break generational cycles of poverty for millions: public health benefits for generations to come. 66 million kids benefit right now.
  • more Americans into medical insurance: lowers premiums significantly, covers 100% of COBRA for people who lost their jobs.
  • workers back to work; including airlines (where thousands of furlough notices were cancelled), restaurants, theaters, and the worst-hurt industries. An electrician or sound engineer laid off by Broadway needs help, too, despite carping by some that the ARP covers “the arts”--well, yes!
  • money to state and local governments for fire, police, safety, teachers, and other services essential to a civil society.

The ARP does all that, and more. It keeps families in their own homes, protecting them from eviction and foreclosure. Eviction and living on the street improve no one’s health, nor the health and safety of our community and nation.

So, yes, this public health nerd is over the moon about the American Rescue Plan. 2020 was a truly horrible year, an annus horribilis. Now we can all look forward to a wondrous, exhilarating annus mirabilis and many marvelous years into the future.

Joseph Yetter, M.D., MPH, is a retired Colonel in the United States Army. He practiced pathology and family medicine in the military and in civilian life on three continents, and has been involved in public health policy during that same career. He’s now retired and is servant to cattle, sheep, chickens, and one old dog. That Benjamin Disraeli quote was chiseled into stone at his medical school long before he attended 1968-1972. It is now chiseled into his mind and heart.

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(3) comments

John ford

I think you may have oversold the ARP a bit. I agree with some of your points. Some of the others like the bail out of blue state pension plans that were in deep trouble before the Covid pandemic came around and the infrastructure projects should have gone through regular voting processes .


John ford: I'm not certain why you would characterize the pension provisions of the ARP as bailing out blue states. I'm unaware of any political slant regarding who gets bailed out. It seems likely that, as always, money tends to flow from blue states to red, on average. It's true that the $86 billion is less than is needed and is a small fraction of the total tab; it's also true that pensions have been in trouble for years, thanks in part to corporate malfeasance and some corrupt (ahem, Jimmy H) union folk, so these problems antedated COVID-19, as you rightly observe.

The small fraction going towards "infrastructure" isn't going to build, but to support losses incurred in the pandemic, it appears (with some exceptions, like upgrading internet for schools). And the Senate parliamentarian was pretty aggressive, so I think reconciliation was reasonable.

Seems to me, anyway. I've been wrong before. Today.




Thank you, Dr. Yetter. [thumbup]

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