Sunday, July 30, 2017
"In Greek mythology, Sisyphus was condemned to ceaselessly roll a giant stone to the summit, only for it to roll back down. In trying to fix health care, we Americans are like Sisyphus — and it’s a little painful to witness the strenuous futility."
"First, let’s look back to see how our health care system evolved. Every U.S. president throughout the 20th century had universal health care high on his agenda."
• In the early 1900s, doctors organized to create the American Medical Association. Policymakers bowed to this deep-pocketed group that had a long tradition of killing legislation that changes health care. Unless the AMA was on board, health legislation was pretty much doomed.
• In 1912, President Theodore Roosevelt attempted mandatory health insurance, though the effort was sidelined by World War I.
• First fundamental change: In the 1920s, the cost of health care increased relative to other sectors — and two hospitals began to offer health insurance to groups of employees. That began the advent of third-party payers.
• Franklin Roosevelt tried to include health insurance in the Social Security Act of 1935, but opposition by the AMA resulted in its being dropped.
• During World War II, employers began to offer health insurance coverage to compensate for wage controls placed on employers.
• Harry Truman proposed a national health care system, but again, the AMA ostracized the plan calling it the S-word: “socialized medicine.”
• During Dwight Eisenhower’s presidency, a 1954 law allowed contributions made by both employers and employees for private health insurance to be tax-free. Millions more Americans were able to gain private health coverage through their employer.
• John Kennedy proposed universal coverage, but when his presidency was tragically cut short, Lyndon Johnson picked up the mantle. He was unable to get universal care, but through tenacity and sheer legislative mastery he achieved insurance for the elderly, the very poor and the disabled. It was 1965, and they called it Medicare and Medicaid. The AMA was vehemently opposed to the legislation, but Johnson seduced them by allowing them to price their own services and procedures. This is when health care costs dramatically and momentously increased.
• In 1973, Richard Nixon signed the Health Maintenance Organization Act to help reduce costs.
• Health care got lost in the policy wilderness for the next 45 years. Then on March 23, 2010, Barack Obama achieved near universal coverage with the Patient Protection and Affordable Care Act.
Fundamental change is inherently disruptive. Fury and acrimony ensued with the passage of Medicare and Medicaid. For example, at the time, hospitals were segregated, but to receive Medicare funds, hospitals would have to become integrated. Imagine how well that went over in the overtly racist South.
But now Medicare and Medicaid are popular and well-accepted programs. Don’t believe me? Ask any senior to give up his or her Medicare and watch the reaction. For me, Medicare is far better than any employer insurance I’ve ever had.
The ACA was another disruptive fundamental change. Indeed, seven years later we are still in the eye of the storm, even though tens of millions of Americans have gained insurance. The ACA needs to be improved, not scrapped. Down the road, Obamacare will be as popular and well-accepted as Medicare and Medicaid.
Before we can achieve universal coverage like all the other industrialized nations, we must decide and demand as a society that health care is a right for everyone — not a privilege for some — and that providing universal coverage is a legitimate role of government. The American Medical Association must be on board.
Until that happens, we’re doomed to futilely toil like Sisyphus. Once we all come together with a shared philosophy, that stone we push will stay atop the summit.