By Andrew D. Coates, M.D., F.A.C.P.
WAMC Northeast Public Radio, July 5, 2013
Some day I hope our national holidays will become occasions for a full stop, protected time for all to reflect upon our lives and our world, our individual and shared aspirations. These days holidays seem, at best, more of a rolling pause, the kind of half-hearted braking that brings, at a stop sign, a traffic ticket.
Such is the momentum of contemporary working life in America, where multi-income households are tethered together with evanescent employments and lifelong debts are the price of higher education. When it comes to a time of personal need, when illness strikes, seeking care often introduces unexpected hassles, followed by financial hardship. In serious illness, the unpaid sacrifice of women family members remains the order of the day.
Recently I’ve participated in dialogue with fellow physicians around the nation about the kind of medicine we would like to practice – the vision we share of what good we might do for the nation if we could win a health program that would meet the health needs of everyone.
A health system that belonged to all of us would serve every patient’s needs and remove the hassles, the fear and the money from caregiving. This would prove liberating not only for patients and their families, but for their caregivers.
Yet as the president’s Affordable Care Act is implemented, we see not only the perpetuation of so many unnecessary and irrational arrangements in our health system, but a new push to piece out care as discrete commercial products, not a calling to serve human beings.
From this viewpoint it seems, today, too easy to despair. Writing over a decade ago, the great American physician and author Eric Cassell captured the full weight of this despairing insight: “Perhaps it will turn out that American democracy simply cannot meet its historical and fundamental promise of equity, and it is in medical care that its failure will be decisively demonstrated.”[1]
Our health system, with such enormous potential to ameliorate disparities and erase injustice, presently often functions in a manner that instead exacerbates social inequities. Yet we all know it doesn’t need to be this way.
The solution is a national health program that would meet the needs of everyone, be free to patients at the point of delivery, based upon clinical needs not the ability to pay. Such a system would mitigate our present chasm between rich and poor, lowering the Gini coefficient.
With access to health care freed from dependence upon private insurance through an employer or a spouse or proving Medicaid eligibility, personal liberation would follow. Our patients would be free of so much fear, hassle, and financial hardship.
But how will we get there from here? My colleagues want a road map. What will it take to win a health system we will truly call our own?
It will take an enormous and historic shift, social forces beyond our control. For all of our power and privilege as physicians, we will not dictate the course of history. Nor can we simply avail ourselves of the existing power structure. During the previous century public health systems were won in spite of democratic power structures, not because of them.
Universal health care, nation by nation, has resulted from victorious campaigns by political parties based upon trade unions, by the threat of social revolution or by social revolution itself. Today in the United States, the mass movement for national health care is incipient, not full-blown, and commercial interests have seized the day. As scandal after scandal comes down, more people are tuning out and there seems even more reason for despair.
The Declaration of Independence says that governments derive their just powers from the consent of the governed. One hundred fifty-six years ago here in upstate New York, at a time when the abolition of slavery still seemed impossible, the great abolitionist and former slave Frederick Douglass observed: “Find out just what any people will quietly submit to and you have found out the exact measure of injustice and wrong which will be imposed upon them.”[2]
So today let’s stop and think about what it means to articulate our vision of public health care for all. We not only announce that we will not quietly submit to the further commercialization of caregiving. We expose unnecessary injustice and preventable wrong. By our words and deeds we find our road map toward great historic change.
When our health system truly becomes our own – and we finally muster, rather than squander, our health resources – we will find a new day of independence for modern caregiving and for everyone in the United States.
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1. Eric Cassell in “The Goals of Medicine: The Forgotten Issues in Health Care Reform,” Mark J. Hanson, Daniel Callahan, eds., Georgetown University Press, 1999, p. 114.
2. Douglass, Frederick. [1857] (1985). “The Significance of Emancipation in the West Indies.” Speech, Canandaigua, New York, August 3, 1857; collected in pamphlet by author. In The Frederick Douglass Papers. Series One: Speeches, Debates, and Interviews. Volume 3: 1855-63. Edited by John W. Blassingame. New Haven: Yale University Press, p. 204.
Dr. Andrew Coates practices internal medicine in upstate New York. He is president of Physicians for a National Health Program.