Changes in American Medicine are immanent and we need the right motive, the right values. Our emotional concern and compassion for others vary, and how we respond to the needs of others is, in turn, influenced by externals. By avoiding missteps of the past we can have a shared vision that benefits all.
Some care narrowly, as with their hands, palms facing each other, carefully separated by only inches. They say, "Let's first take care of this group, these few things." Others spread their arms wide and say, "Let's take care of as many we can now, no waiting." still others place their hands somewhere in the middle.
The three approaches are complementary, providing depth, breadth, and patience to the project. And this inclusiveness of vision provides the combination of forces most likely to result in effective meaningful change. When we listen (really listen) to one another we discover that we are not as divided as we thought.
The next decisions in healthcare are not without potential danger. American Medicine has at times taken shocking turns. It is a story, unfortunately, of persistent and endemic inequalities and inequities. Racial, ethnic, and economic factors have often influenced and tainted major policy decisions. Decisions such as: Who shall receive comprehensive preventive health care, and who shall not? Who shall benefit from the best we can offer, and who will be left out? Who shall simply be ignored and allowed to die quietly, and who shall be given another chance to live? Who shall gain easy access to the emergency room and beyond, and who shall be routinely turned away once the urgent situation has passed? And who will pay for it all?
Doctors in the 19th century had few tools. They could work to alleviate pain with morphine, surgery was crude and dangerous, and infectious diseases caused the bulk of morbidity and mortality. This changed with anesthesia in 1840 and then with penicillin in 1928. Progress has been steadily accelerating as we now cope mostly with chronic illness and "degenerative" diseases. For those with access to the most well-equipped hospitals admission raises the anticipation of miraculous medical and surgical cure. Minimally-invasive surgery should leave no scar. Perfection is anticipated when a baby is born. Death is seen as a failure. But through each era, medical resources have been distributed inequitably.
Missteps are recognized in retrospect and often after the weakest are hurt. Corrective efforts follow but may miss their mark.
For example, Roy Porter in "The Greatest Benefit to Mankind" (Norton Publishers 1997) writes:
"By 1900 (in the US) the management of health was...a tangle of voluntary, religious and charitable initiatives, as was primary care for the needy, while medicine for those who could afford to pay was essentially a private transaction” (Porter; p. 631).
In the early part of the twentieth century:
"War and the threat of war did not merely expose the ill health of people in modern industrial society; they provoked grave anxiety generally about the nation's health. Many...became incensed at the thought of sickly soldiers and an enfeebled national stock...The response...was the eugenics movement, which directed the health debate to the problem of fitness, understood in national and racial terms (emphasis added)...Unemployment and poverty were (therefore seen as) results, not the causes, of social incapacity" (Porter; p. 639).
The answer? In 1930 eugenists championed stricter immigration laws and secured the first compulsory sterilization measures; 15,000 Americans were sterilized by 1930" (Porter, p. 640). But: "Public health advocates...opposed eugenic policies (and)...demanded a comprehensive health system, administered by local health authorities and funded by taxation." (Porter, p. 640). Universal (or nearly-universal) health coverage has been the goal of several Presidential administrations in modern times including those of Truman, Kennedy, Johnson, Nixon, Carter, Clinton, and, of course, Obama.
"According to the CDC...for the first three months of 2016 the uninsured rate was 8.6% down from 9.2% (the year before), and from 15.7% before the Affordable Care Act was signed into law. For just the 18-64 demographic the same study shows the uninsured rate at 11.9% down from 22.3% in 2010 when the ACA was signed into law. These (figures) represent the lowest uninsured rates in over 50 years according to the studies (emphasis added)" (obamacarefacts.com/uninsured-rates/)
The uninsured rate for those over 65? Essentially zero. Why is that not the statistic for all age groups?
How can we come together as informed citizens of the wealthiest society in history to provide compassionate and equitable healthcare for all Americans? Let's share our ideas and make this happen. Let's do the right thing.
Anita
