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The resurgence of Covid-19 is again leading health care systems across the globe to brace themselves. And with deep scars from early in the pandemic, leaders are again calling on people to get vaccinated. One prominent reason they cite for vaccination is to protect hospitals and health care workers.

In the U.S., this message is not working.

In his recent speech to the nation, President Biden pleaded, “Let me say again and again and again: Please get vaccinated. It’s the only responsible thing to do. Those who are not vaccinated are causing hospitals to become overrun again.” A day earlier, Dr. Anthony Fauci described a “very strong urge” to get people vaccinated because, “There will be a big stress on the hospital and health care system.” In Cleveland, six medical systems took out a striking full-page newspaper ad to beg “Help.”

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These messages are collectivist in principle, but also appeal to self-interest. Protecting your own hospital and its workers means they will be available to serve you if you get Covid-19. While such a message seems to fall on deaf ears in the U.S., it appears to resonate elsewhere.

In the U.K., for example, which began seeing the effects of Omicron ahead of the U.S., officials from England’s prime minister to managers of top soccer clubs have called on the public to “protect the NHS.” The NHS, or National Health Service, is the U.K’s taxpayer-funded, government-run health system. Although it is impossible to attribute success to a single message, England has been vaccinating people at a rate three to four times greater than the U.S since mid-December.

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The British public loves the NHS. People who use it pay little or nothing at the point of care, and it is among the highest performing health care systems in the world. In fact, more than half the population identified the NHS as the thing that makes them most proud to be British — above the armed services, the royal family, and the BBC. It is held in such high esteem culturally that it was featured in the opening ceremony of the 2012 Summer Olympics in London.

Most of the criticism the NHS faces is about underfunding. More than three-quarters of the public wants funding for the NHS protected above all other government activities. During Covid-19, this concern heightened into public worry about whether services would be available. U.K. residents know that Covid-19 can overwhelm the system they rely on and want protected.

That loyalty is what makes a message like “protect the NHS” ring true. The system is nearly universally seen as a public good, and in need of protecting. Most people in the U.K. understand that getting vaccinated benefits the NHS precisely because the public has an equal stake in its success. An unvaccinated person who ends up in the hospital takes resources such as beds, doctors, and nurses away from others.

In the U.S., we like our doctors but are not loyal to the health care system. Many Americans valorize the doctors and nurses working on the frontlines of Covid-19, but you would be hard pressed to find someone who wants to protect the medical groups, HMOs, and other complex insurance convolutions undergirding our system. In fact, just 19% of the public believes the health care system works at least “pretty well,” less than in every other country studied.

That lack of loyalty to the system is reasonable. Many families, even those with health insurance, have been financially harmed by a system they pay increasingly unreasonable amounts to support. In 2019, about 20% of Americans with private insurance reported being contacted by a collection agency about a medical bill. And nearly 60% of all people in the U.S. who declare bankruptcy identify medical expenses as a contributor. This is unheard of in most other high-income countries.

It is also difficult for the public to justify protecting a health care system that has, in parts, profited from the pandemic. The five largest private health insurance plans in the nation made more than $11 billion in profits in early 2021, after record profits a year earlier. And some private, wealthy hospital systems reportedly made millions of dollars — and a few made billions — in the past two years. Some might reasonably ask, what exactly needs protecting?

Perhaps Americans’ trust in their own physicians will outweigh attitudes towards the larger health care system in making vaccine decisions. But without underlying fixes to the health care system that create a recognized, legitimate public good, broad vaccine messages about protecting our hospitals and health care system may continue to give Americans little reason to act.

Gregory Stevens is a professor of public health at California State University Los Angeles, co-editor of The Medical Care Blog, and co-author, with Leiyu Shi, of “Vulnerable Populations in the United States” (Wiley, 2021).

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