Health­care re­form ef­fort re­flects the hopes and fears of a cen­tury

Modern Healthcare - - Editorial -

Just one cen­tury af­ter first be­ing pro­posed, re­form is here

That was a rough 100 years.

And the past year of de­bate on health­care re­form seemed like all 100 wrapped into one. In fact, if you look at the chronol­ogy on pre­ced­ing pages, you will see that what has hap­pened since 2009 in many ways en­cap­su­lates the U.S. re­form war that has raged since the early 20th cen­tury. The in­tense par­ti­san­ship and the cries of “so­cial­ized medicine” and the “death of free­dom” are like re­runs of a bad soap opera.

One of the many ironies of the lat­est episode is this: The Demo­cratic bill that was signed into law last week was very sim­i­lar—if not more moderate—than the plan pro­posed by Pres­i­dent Richard Nixon in the 1970s. It in­cor­po­rates ideas floated by con­ser­va­tive thinkers in the 1990s. It is sim­i­lar to the plan now op­er­at­ing in Mas­sachusetts, even though the man who signed the mea­sure, for­mer Gov. Mitt Rom­ney, has been try­ing to run away from it. In short, the na­tional re­form bill that spurred all the bit­ter­ness con­tains lots of Repub­li­can DNA and might have been en­acted 40 years ago if it weren’t for the per­sonal prob­lems of Nixon and the late Sen. Ed­ward Kennedy and the dis­trac­tions of a na­tion in tur­moil.

We shall see if this law reme­dies what ails the U.S. health­care sys­tem. One prob­lem is that it leaves the na­tion with an overly frag­mented scheme and over­lap­ping realms of cov­er­age. The patch­work of Medi­care, Med­i­caid, vet­er­ans care, em­ployer-spon­sored care, etc., will re­main. Most es­ti­mates of the bill’s im­pact sug­gest that a few mil­lion peo­ple will still go without cov­er­age.

And we shall see if the con­ces­sions made in draft­ing the leg­is­la­tion were too costly. What helped pass this law was the co­op­er­a­tion of many seg­ments of the health­care in­dus­try. They cal­cu­lated that the long-term ben­e­fit of some 30 mil­lion ad­di­tional in­sured peo­ple out­weighed the draw­backs. That was in con­trast to pre­vi­ous at­tempts, most re­cently the Clin­ton plan in which in­sur­ers, providers and drug com­pa­nies staged a re-en­act­ment of “Mur­der on the Ori­ent Ex­press.” This time, ac­cord­ing to the Cen­ter for Pub­lic In­tegrity, more than 1,700 com­pa­nies and or­ga­ni­za­tions hired more than 4,500 lob­by­ists—eight for each mem­ber of Congress—to in­flu­ence 2009 leg­is­la­tion for bet­ter or worse.

Still, and for all the po­ten­tial prob­lems, this law is at least a good start. It sets the na­tion on a course to­ward uni­ver­sal cov­er­age and at­tempts to bring some ra­tio­nal­ity and eco­nomic ef­fi­ciency to a health­care sys­tem in name only. The mea­sure should end the cru­elty of our cur­rent in­sur­ance prac­tices such as de­nial of cov­er­age be­cause of pre-ex­ist­ing con­di­tions and ex­pul­sions of peo­ple who get sick.

The de­bate on the leg­is­la­tion to achieve th­ese goals of­ten did not bring out the best in Amer­ica, now or in the past. Ap­peals to fear and to greed—you’re go­ing to have to pay for some dead­beat to get health­care—were hardly flat­ter­ing.

In his book The Heal­ing of Amer­ica: A Global Quest for Bet­ter, Cheaper, and Fairer Health Care, which should have been a must-read for all Amer­i­cans dur­ing this de­bate, jour­nal­ist T.R. Reid re­counts an ex­pla­na­tion of the French health sys­tem’s em­pha­sis on equal ac­cess of­fered by one of its doc­tors: “It would be stupid to say that ev­ery­body is equal. Some are rich and some are poor. … But when we get sick—then ev­ery­body is equal. Ev­ery­body must have an equal right to the best med­i­cal treat­ment we can pro­vide. … Surely, that’s the rule of health­care in ev­ery coun­try.”

For at least 100 years, it hasn’t been the rule here. With the new leg­is­la­tion, maybe it will be soon. Be­cause surely, we’re all Amer­i­cans, aren’t we?


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