A history of reform: Political pundits or patients?

Attempts to change healthcare are not new to this day and age. It just takes a minute to see where the trends emerge throughout our history as our country has tried to work on healthcare. For an exhaustive timeline of healthcare events and milestones see the the Kaiser Family Foundation Health Reform website.

As early as 1916 we saw calls for change in healthcare in the United States. “At present the United States has the unenviable distinction of being the only great industrial nation without compulsory health insurance,” Yale economist Irving Fisher. Even at this time, almost 100 years ago, there was a recognized need that the country needed to start to tackle health as a priority area before it became too big a problem.

However, back in the early 20th century, just as today, politics were interfering with efforts to bring about change.

During a radio debate on November 12, 1935, Morris Fishbein, the editor of the Journal of the American Medical Association, said that publicly funded medical services in the United States “would socialize if not communize one phase of American life…. We shall become a nation of automatons, moving, breathing, living, suffering and dying at the will of politicians and political masters.” (American Medical Association Bulletin, November, 1935).

And really, is this tactic so different from what we saw during our recent healthcare debate?

“We should not have a government program that determines if you’re going to pull the plug on grandma.” —Sen. Chuck Grassley (R-IA), Aug. 12, 2009

And even some of our elected physician members of Congress could not avoid interjecting fear into the political discourse on healthcare.

“To our seniors, I have a message for you: you’re going to die sooner.” –Sen. Tom Coburn (R- Okla.), Dec. 1, 2009

Universal healthcare is often touted as one solution for the growing problem of the uninsured in this country. After all, what about having quality, affordable healthcare for all is a bad idea? Yet we still have a country that differentiates itself from the rest of the world in what it does not offer its citizens.

From the Atlantic: “The above map shows, in green, countries that administer some sort of universal health care plan. Most are through compulsory but government-subsidized public insurance plans, such as the UK’s National Health Service. Some countries that have socialized and ostensibly universal health care systems but do not actually apply them universally, for example in poverty- and corruption-rife states in Africa or Latin America, are not counted.”

To understand how the United States is now at a place where achieving some level of universal healthcare coverage is so difficult, read Vladeck’s article in the American Journal of Public Health. So yes, to get to a place where we are covering everyone through some type of healthcare mechanism, we have a lot of work to do.

One major problem is that the American Public sees healthcare very differently. In fact, it appears that our political affiliations and who we support lead us to a place where we prioritize healthcare at almost extremes.

In a Gallup poll released yesterday, there was a striking difference between supporters of President Obama and supporters of Governor Romney on the topic of healthcare. In fact, the differences were so striking that the biggest gap in the poll was on healthcare (29 point difference). And while it is well established that based on your political affiliation you may have differing opinions on the role of government, this poll was not asking about the role of government in healthcare, but rather simply what topics are most important from the supporter’s viewpoint.

Interestingly enough, those who oppose certain healthcare efforts like the Patient Protection and Affordable Care Act, have stronger opinions about the law than those who support it.

Today’s political climate is really not that different from the one that existed almost a decade ago; people have opinions, and those opinions elect officials who have opinions.

We all think we know what is best.

The problem is that why we wait to determine whose opinion is going to win out, there remains a public that is suffering and in need of help. In a fascinating article in the New York Times entitled “What Can Mississippi Learn From Iran?,” we see examples of innovation springing up to better meet the needs of the community. The bottom line is that we need meet the community where they are at, and often where they are at is light years from where Washington, DC thinks they are at.

While we will not likely see an end to some of the problems in healthcare any time soon, we must recognize that in order for us to collectively move forward it is the voice of the patient we must listen to.

We disagree on much, but that is only when we focus on ourselves.

History has at least taught us this much.

Dr. Miller has his doctorate in clinical psychology and is an Assistant Professor in the Department of Family Medicine at the University of Colorado Denver School of Medicine where he is the Director of the Office of Integrated Healthcare Research and Policy. His core task is to integrate mental health across all three of the department’s core mission areas: clinical, education, and research. Opinions expressed here are his own and not those of his employer.

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  • http://www.Spherit.com Spherical Phil

    Great piece!

    One thought.

    “You never change things by fighting the existing reality.
    To change something, build a new model that makes the existing model obsolete.”
    ― Richard Buckminster Fuller

    The existing model of healthcare in America is far worse than obsolete. Politicians’ opinions don’t really count, it is we the people who must come up with and build a new model for healthcare.

    Spherically Speaking
    Phil