All of us are Medicaid beneficiaries — whether we realize it or not

Imagine a major city with no streetlights. It would be more difficult to navigate at night, its downtown would be empty after dark, businesses would avoid locating there, shops and restaurants would close early, and crime would flourish. The well-being of every resident, even those who never venture downtown, would suffer.

Now, imagine a major city with no hospitals.

As with streetlights, the ripple effects would diminish the well-being of every resident. They would have to travel for any kind of inpatient care, and they would have nowhere to go for lifesaving care in an emergency. With no available facilities for treating complex conditions, doctors would avoid practicing there, reducing available healthcare even further.

The well-being that amenities like streetlights and hospitals produce are public goods that are available to everyone regardless of whether they pay for them. Since no private company could make a profit from a service that everyone can obtain for free, communities rely on government support in one form or another to make them available.

In the case of healthcare, a key part of that government support is at serious risk. Most hospitals depend on reimbursement from Medicare and Medicaid to make ends meet, and Republicans in Congress are considering proposals to shrink Medicaid substantially with changes like work requirements that could dramatically reduce enrollment.

The ripple effects of a shrunken Medicaid program would affect everyone. To appreciate the full impact, we must look beyond the program’s most visible role of providing health coverage to more than 70 million people who could not afford it otherwise.

We must look even beyond its support for sustaining a large portion of the country’s hospitals that would face an insurmountable burden of uncompensated care if those people did not have coverage.

As with streetlights, we must look at the public goods on which we all rely that would be lost.

To start, Medicaid provides peace of mind from knowing that hospitals and their emergency rooms will be available when we need them — even if we never actually use them. Many nursing homes would also find it difficult to operate without Medicaid, placing new burdens on family caregivers.

Beyond the disappearance of healthcare services, shrinking Medicaid would undermine support for the pipeline of new doctors and other clinicians. In 43 states it helps to fund their hands-on training in hospitals.

Medicaid also underlies many kinds of healthcare innovation.

It did this in supporting state experiments to provide home and community-based care for frail adults in lieu of institutionalization and to provide special services for people with autism and other developmental disabilities.

It supports innovation further by paying for prescription drugs, which creates an important market for companies that develop new ones.

Public health also rests on a foundation built on Medicaid, which funds preventive care that reduces rates of many diseases. Most important, it covers immunizations against infectious diseases for many people who could not otherwise afford them.

Immunization not only makes those who receive them less susceptible to those diseases, it can also create community immunity in which a disease disappears entirely from a population.

Despite what some skeptics may claim, vaccination has been one of the most important contributors to the dramatic decrease in illness and premature death that has occurred over the past several decades.

Medicaid also produces significant social and economic benefits. It mitigates health disparities based on wealth, geography, and race. Research shows that it even reduces overall rates of poverty. Losing both of these effects would undermine community cohesion.

By underlying the financial stability of hospitals, Medicaid also supports thousands of jobs that they and other healthcare businesses create, which would be lost if more of them closed.

Losing those jobs would threaten the economic viability of entire regions, especially in rural areas. And more illness in the population would place new burdens on surviving hospitals, increase demands on public health services, and likely cause premiums for private insurance to rise.

These ripple effects of shrinking Medicaid would be felt by everyone sooner or later. Losing the program’s public goods would undermine the foundation of much of our health, social, and economic well-being. Let us hope that before voting to shrink it, members of Congress understand the extent of harm they could cause.

Robert I. Field is professor of law in the Kline School of Law and professor of health management and policy in the Dornsife School of Public Health at Drexel University and the author of “Mother of Invention: How the Government Created ‘Free-Market’ Health Care.