The debate over healthcare reform has reached fever pitch. Loaded words splash across the front pages of newspapers each morning, but 47 million Americans have no health insurance and 17,000 lose their coverage daily. What's being done in Washington? The leading bill under scrutiny, "America's Affordable Health Choices Act," marks the seventh time in U. S. history that the topic of national health insurance has been seriously debated in a public forum. As lawmakers take a four-week recess, August will make or break the effort to overhaul our healthcare system. Let's take a dive into the history books and try to understand the reasons why this moment is so urgent.
We'll begin by heading back to the founding of the "social medicine" movement. In the early 1880s, German politician Dr. Rudolf Virchow was challenged to a duel by Chancellor Otto von Bismarck, a fierce conservative who was frustrated by Virchow's insistence on public health as a human right and top government priority. As the challenged party, it was tradition for Virchow to select the weapons for the fight. He made an unlikely choice, producing two sausages one of which had been inoculated with cholera, a deadly disease seen as emblematic of poverty. The Chancellor withdrew from the duel in short order. Virchow's act was intended to give the problems of the poor a visceral reality for Bismarck. It appears that he was successful. In 1883 the German government enacted the world's first modern health insurance system.
Virchow understood the most effective way to win vital causes: reframe the debate by asking opponents to walk a mile in an outsider's shoes. It is difficult to grasp the urgency of this debate unless you have lived with the fear of having no health insurance or been told that vital medical procedures could not be covered because of your "pre-existing condition." Following in Virchow's footsteps, hundreds of public health visionaries (including Parkhurst Hall's newest resident) have tried to help us understand this, showing the clear relationship between economic woes and health disparities. For a lucid demonstration of this argument, one should read the required book for the Class of 2013: Tracy Kidder's "Mountains Beyond Mountains."
Why doesn't the United States take action and make our world-leading medical technology live up to its promise? It isn't for lack of trying: the American Association for Labor Legislation's plan in 1915, FDR's additions to the Social Security Act of 1935, the Wagner-Murray-Dingell Bill of 1943, the Kennedy-Griffiths Health Security Act of 1970, and Clinton's employer-mandate proposal in 1993 all sparked passionate debate before being shot down. Though each proposal differed, they shared the same opponents. Reactionary elements of the American Medical Association joined with insurance companies and Big Business to undermine each proposal, using scare tactics and smear campaigns. Combined with the lack of solidarity and grassroots support that plagued each effort, these countermeasures triumphed every time. An appalling number of American citizens remain uninsured.
Did each of these plans have flaws? Yes but instead of accepting the task of fixing them through compromise, we implemented stop-gap measures like Medicaid, which sounds a lot better than it really is to anyone who hasn't had to rely on it and fall victim to its "spend-downs" and seemingly random gaps in coverage.
This month, our country has one last chance to get it right. No one says it will be simple, and there will be a large number of competing voices. Current students may not remember, but the Insurance Association of America's famous Harry and Louise television ads helped turn the middle class against Clinton's plan, repeating misleading statements and misrepresenting key parts of the bill. The result was the dominance of managed care for almost a decade. Today, Rush Limbaugh and friends are no easier to tune out. But it is possible to fight back. Call your state's senators and representatives. Tell them why this issue matters to you they will listen.
Healthcare is not another commodity. The pathologies of nations (including our economic crisis) are inextricably linked to health disparities. The time has come for a new New Deal. It is up to all of us to make our voices heard the future of the nation and even our own lives may depend on it.
