A Cure For Our Cultural Ills? We Start Anew. Health Care For All.

Posted on | December 5, 2019 | 2 Comments

Mike Magee

At a Code Blue presentation last week, questions centered on next steps in health reform – all the way vs. incremental, and not whether, but when and how fast. Health care reform in America has become a cultural issue.

Health care as fundamental to building a nation and its culture from scrap was what drove the military’s decision under the Marshall Plan. In the re-build of Germany and Japan, we elected to start with a health plan – in part because we recognized that all other social determinants – housing, nutrition, education, clean air and water, safety and security – would be enhanced in the process leading to a tradition that could support stable democracies.

This is essentially the same challenge we as a country (having wandered so far off course as to elect Trump) are faced with today. Changing culture, as health professionals know, is a tall order. It is about compassion, understanding and partnerships. It is about healing, providing health, and keeping individuals, families and communities whole. And – most importantly – it is about managing population-wide fear, worry and anxiety.

What we are asking of the people, and the people caring for the people, is to change their historic culture (one built on self-interest, hyper-competitiveness, and distrust of good government). This is a tall order – something that parents, pastors, politicians and physicians equally recognize. Things evolve, and difficult things take time. But what happens if you run out of time, if the threats of delay or incrementalism create risks that outweigh or negate rewards. What then?

What then usually involves some middle path, one that emphasizes self-determination but not self-destruction. In the case of health reform, this is the argument for provision of a public plan (similar to Medicare) as a voluntary option that is available to all comers. In the response will be revealed next steps in health reform.

If we choose to go this route however, the mischief makers who spent a decade undermining the Affordable Care Act must be effectively sidelined from the start. The essentials? The public plan must be open to all. Insurance must be a requirement and mandated as such with penalties. Medicaid expansion (in combination with the new public offering) must be required in all states without exception. And a complete benefit package as delineated in the ACA must be required (no skimpy substitutes). In other words, the public offering must be muscular, nationwide, and accessible to all comers.

At the same time, we must disabuse ourselves of any notion that a cultural shift with health care as the leading edge will be simple or easy. We need only recall those post-WWII years to remember that, as we were building out national health systems for our vanquished enemies, the AMA, PMA and allies simultaneously branded Truman a “socialist” and dispatched his plan for national health care as “socialized medicine.” Power, profit, and persistence prevailed. It took nearly two more decades to move the dial on Medicare and Medicaid.

What we witnessed this past week during the Impeachment hearings was a grim reminder of how far protectors of the status quo are willing to go. An epic struggle by those in power once again unleashed fear and worry to fuel hatred and resentment. It is not a pretty picture.

But putting that aside, it is useful to acknowledge what our former military leaders stated as Germany and Japan sought to rise from the ashes. “We start with health care because it is an anecdote to fear, worry, and hatred.” Using the same logic, our distressed American culture will benefit greatly from universal health care. We start anew. And given a bit of patience, and some wiggle room to choose a better future, we might be surprised to learn that we are a bit more “exceptional” than we might at first appear.