We’ve Built National Health Care Systems Before.

Posted on | October 27, 2020 | 3 Comments

Mike Magee

Health care reform in America is now the path we must travel to uncover our own “exceptionalism.” It won’t be easy, but we’ve been there before.

Health care, fundamental to rebuilding a nation and its culture from scrap, was what drove the military’s decision under the Marshall Plan in 1947. In the re-build of Germany and Japan, we elected to start with a health plan – in part because we recognized it as the fundamental underpinning of all other social determinants (housing, nutrition, education, clean air and water, safety and security) necessary for 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 delays and incrementalism carry risks as well – for example if global warming reaches a point of no return or a pandemic spirals out of control.

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. A huge response to such an offering could be determinative.

If we choose to go this route however, the trial must be given a fair chance. 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 (including the 12 current hold-outs). 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 easily 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 Marshall Plan years to remember that, as we were building out national health systems for our vanquished enemies, the AMA, Pharmaceutical Manufacturers Association, and allies simultaneously branded Truman a “socialist” and dispatched his plan for national health care as “socialized medicine.” It took nearly two more decades to move the dial on Medicare and Medicaid.

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 after WW II. “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.

Comments

3 Responses to “We’ve Built National Health Care Systems Before.”

donorcure
October 28th, 2020 @ 12:49 am

Many Americans trusted intuition to help guide them through this disaster. They grabbed onto whatever solution was most prominent at the moment and bounced from one (often false) hope to the next. Hopefully, our health care will be much stronger right now.
ARTHUR L ULENE MD
October 28th, 2020 @ 5:20 pm

Mike…. .I think it’s time to stop talking about a “public plan” or a “public option”. Nobody has any idea what that means—even after Joe Biden gets done explaining (or maybe I should say, “especially after he gets done explaining it”. We should simply offer other ways to get “MEDICARE”. (There, I said it.) You could buy it at full price (whatever that turns out to be for people under 65)…. or your state could buy it for you if you’re broke…. or there could beMedicare F, G and N options that anyone could buy. Everyone understands Medicare. Almost everyone likes it. Let’s just make Medicare THE public plan. You want it, you can buy it. You don’t want it, then you stick with whatever you like. (But no getting in at the last minute when you’re sick.) BTW: Employers could choose to buy some version of Medicare for their employees if they don’t like the private insurance company they’re working with now.
Mike Magee
October 28th, 2020 @ 5:25 pm

Agree with simplicity, transparency, and equity. Best way forward is likely in front of our noses. Thanks, Art!