Is America breaking its health care promise to you?

I took my son to be tested for COVID-19 during the Thanksgiving break. The experience was nightmarish: long lines, disorganization, confusion and ultimately a price tag of $159 for rapid test results that took four days. Nothing about the process worked. 

This is America — a first-world country with a third-rate response to a pandemic that has been raging for close to a year. And COVID-19 is just the tip of the iceberg. America’s public health capacity and its health care systems are melting like the Wicked Witch in “The Wizard of Oz.” 

Public health ensures that your public is healthy. That means critical infrastructure, good prevention, strong messaging and ensuring that resources are available to respond to public health challenges for large populations.

Health care is when you go to your doctor or a hospital for an emergency like COVID-19 or a chronic disease like diabetes. 

Both parts of the equation matter, and both are broken. 

Don’t take my word for it. Read what the American Medical Association is saying about its own system. “The U.S. health system that exists today is a hodgepodge of ideas, programs and regulations that is both extraordinarily expensive and highly inefficient. And despite its size and technological advancements, our health system is beset by tremendous gaps and inequities that favor some groups while unfairly disadvantaging others—minoritized communities, people living in rural areas, and people who are unable to afford or access health insurance, just to name a few.”

Even before the pandemic, local public health agencies around the country had lost almost a quarter of their overall workforce going back over a decade to 2008 — a reduction of almost 60,000 workers, according to national associations of health officials. Our country spends about $3.6 trillion a year on health, but less than 3 percent goes to public health and disease prevention.

We are dramatically under-investing in organizations like the Centers for Disease Control and Prevention (CDC), whose emergency preparedness budget has endured a 30 percent cut since 2003. Warnings about the CDC’s funding status are not new or unique to COVID. In December 2014, Congress appropriated $5.4 billion to fight the historic Ebola epidemic that was raging in West Africa. Since then the CDC budget has not kept pace with our nation’s growing public health needs and emerging threats. We tend to invest during a crisis but not before or after.

Even with good infrastructure, you need good communications and consistent public health messaging. From the start of the Trump administration, there has been confusion around masks, tests and now vaccines. The result is a lack of confidence in public health institutions just as we head into the next holiday season when more people need to be tested.

COVID-19 testing delays reflect the chronic underfunding of public health and the problems plaguing our health care system. That is a toxic combination of problems.

Thankfully we have a new administration promising to put public health and health care back at the top of the national agenda. It is unfair to doctors, nurses, lab technicians and all those who deliver care and develop public health policy to be working in a dysfunctional system.

What needs to be done?

We need to realign our health system around prevention and treatment, not just of COVID-19 but around the wider set of health challenges we face. 

Data has to be shared more effectively, and inequities addressed, including systemic discrimination inside our public health system.

We need good public messaging and a public that demands it. 

We need to train a new workforce that can deliver care in a timely and effective way. Although our spending on health care as a percentage of GDP has increased, the health outcomes have not. 

Lastly, corporations should not be allowed to acquire diagnostic centers and health care providers that feed their bottom line at the expense of our own basic needs. Deal-making in the U.S. health care sector, including mergers and acquisitions, hit $533 billion in 2019, up 26 percent over the previous year. 

There is nothing inherently wrong with companies bringing expertise to aging payment structures, data problems and efficiency as long as that leads to better health care access, lower costs, improved care quality and satisfied patients.

It’s heartbreaking to read and think about our current crisis and a health care and public health system that make promises to take care of us and then breaks them. We need repairs before the systems are tested again.

Tara D. Sonenshine is former U.S. under secretary of state for public diplomacy and public affairs.