To build back, look to 1995 and 1945

A fundamental principle of medicine is that the only way to face bad news is to confront it. That is why the common refrain, “We’re better than this,” and Congressman Kevin McCarthy’s appeals to avoid confrontation in the interest of “bringing our nation together,” have all the appeal of a delayed or missed diagnosis.

The Jan. 6 seditious attacks by our president, his enablers and white supremacists laid bare a disease that continues to fester and spread within our body politic. From QAnon followers to the Proud Boys, the last four years have produced a disturbingly large collective of zealots willing to commit violence to protect Donald Trump at the expense of our democracy.

Beyond his support for insurrection, his authoritarian tenure includes human rights abuses against immigrants, misuse of federal agents to harass protesters and the complete mismanagement of the COVID-19 pandemic, with a death toll likely to reach 500,000 Americans in the next few months. As with Nazi Germany and South Africa under apartheid, these crimes involve racism, disinformation and erosion of public trust. They are egregious and deepseated.

To address these abuses, and heal our nation, we must be open and honest. Medical history offers a playbook for how to successfully excise these cancerous cells and pursue a cure. In Germany in 1945 and South Africa in 1995, strict legal and public accountability were married with fundamental expansion of universal social services to rebuild confidence and trust in government’s ability to assure health, safety and security.

At the end of World War II, the Allied forces established the International Military Tribunal. One of the series of trials, which opened Nov. 19, 1945, in the Palace of Justice in Nuremberg, delved into egregious examples of medical criminality, including Nazi experimentation on human subjects. These trials are often cited as an example of retributive justice. Of 23 defendants, seven were hanged, seven acquitted and the rest given sentences from 10 years to life in prison. These judgments were conducted under the direction of U.S. judges and prosecutors and fully compliant with U.S. standards of criminal procedure.

President Truman paired these efforts to address abuses with programs to improve the welfare of the German people. Using American taxpayer resources, our nation established universal health plans to assure the future good health of the Germans. An analysis of the German and Japanese programs as forms of “restorative justice” made some years later by the Rand Corp. summed up the Marshall Plan’s rationale: “Nation-building efforts cannot be successful unless adequate attention is paid to the health of the population. The health status of those living in the country has a direct impact on the nation’s construction and development, and history teaches us it can be a tool in capturing the goodwill of the nation’s residents.”

A similar reparative approach was utilized in South Africa in 1995. Nelson Mandela’s Truth and Reconciliation Commission conducted over 1,000 public hearings on their road to a free democracy, offering amnesty to those who publicly admitted past crimes of sectarian violence and asked for forgiveness. Less recognized, Mandela simultaneously prescribed fundamental social service reform, including free primary level public health care for all in 1996 serviced by over 350 newly constructed health clinics by 1997.

The crimes of Donald Trump, his followers and enablers will soon be fully exposed. Denying the disease that is Trump, his enablers and coordinated white supremacists assures further spread.

Our nurses and doctors know that, to allow complete recovery from a critical illness, we must provide the safety and security of a healing environment, one marked by compassion, understanding and partnership. As with Germany and South Africa, an obvious first step toward rebuilding our own nation would be to move forward without delay in assuring basic universal health coverage for all Americans.