The last chapter (8) of HealthConsuming considers whether Americans can become “health citizens.”

“Citizens” in this sense goes back to the Ancient Greeks: I return to Hippocrates, whose name is, of course, the root of The Hippocratic Oath that physicians take. Greece was the birthplace of Democracy with a capital “D.”

Hippocrates’ book The Corpus is thought to be one of the first medical textbooks. The text covered social, physical, and nutritional influences, and the concept of “place” for health and well-being. Here, the discussion detailed the roles of air and water for health. The Hippocratic texts also coached doctors to consider the social and political status of their patients, which shaped lifestyles and, ultimately health. Hippocratic writings refer to the “health of the polis.”

What of the health of “our polis,” people living in their communities in the U.S.? As Esther Dyson posed in a recent email exchange with me, “do we want to ‘own’ or ‘rent’ our health?”

In the previous chapter, I detailed the “deaths of despair” and reversal of life span improvements in America, largely due to social determinants like education, social isolation, job and financial insecurity and income inequality.

In this last chapter of HealthConsuming, I cite Sarah Kliff’s revelatory story in Vox, uncovering a political shift “after visiting Kentucky and meeting with registered Republicans in the state who enrolled in Obamacare, had voted for Donald Trump for President, and began to understand what eroding or  repealing the Affordable Care Act could mean for them in terms of losing their coverage, and ultimately health and financial security.”

I note that, by the time Americans voted in the 2018 mid-term elections, it was no surprise that lower-income Americans were highly concerned about paying higher premiums, most people earning over $75,000 a year were also very worried about covering the costs of health insurance.

This was equally true for people whether enrolled in Medicare, Medicaid, or covered by private insurance. By late 2018, seven in ten Americans had a negative view of the U.S. health care system, Gallup learned. Most Americans favored the government ensuring healthcare for all, shown in the chart…but not necessarily running that system.

A Kaiser Family Foundation Health Tracking Poll published April 24, 2019 found that the health care policy priorities for most Americans were to lower health care and prescription drug costs, ensure the ACA’s coverage of pre-existing conditions, and protect people from surprise medical bills. Two-thirds of people also prioritized expanding financial help to include more people who buy insurance on the ACA marketplace.

But wait — 53% of people in the poll also called “repealing and replacing the ACA” a priority. 

So are these health consumers saying they want better government-supported health care coverage than currently available through the ACA marketplace plans? Or is there a misunderstanding or disconnect of what the Affordable Care Act plans cover?

At the end of the book, you will have time-traveled from the Ancient Greeks to my town of Philadelphia. I show you this map of the city illustrating that between North Philadelphia (ZIP code 19132) and a Center City neighborhood, (19106), there’s a 20-year gap in life expectancy. These neighborhoods are about 4 miles apart.

In 1787 after the Constitutional Convention, Mrs. Powell asked Dr. Benjamin Franklin, “Well, Doctor, what have we got? A Republic or a Monarchy?”

Dr. Franklin responded: “You have a Republic….if you can keep it.”

While Ben was referred to as “Dr.” Franklin, he didn’t have a medical degree at all. But some influential doctors in America have come out in favor of universal health care: the American Medical Association issued a statement in JAMA titled, “Health Care in the United States: A Right or a Privilege.” “I hope that all physicians, including those who are members of Congress, other health care professionals, and professional societies would speak with a single voice and say that health care is a basic right for every person, and not a privilege to be available and affordable only for a majority,” Dr. Bauchner of the AMA urged his fellow doctors. “The solution for how to achieve health care coverage for all may be uniquely American, but it is an exceedingly important and worthy goal, emblematic of a fair and just society.”

We are at a moment in America which most Democrats, Independents and Republicans recognize as health-insecurity-for-all. Addressing health care reform at the fundamental level of universal access. baking health into public policy, leveraging evidence-based technology and ensuring privacy driving public trust will help America keep her Republic socially, clinically and fiscally fit.