HEALTH CARE: VISION, WORD, AND WILL

August 20, 2009

My friend Joanie tells the story of her bout with strep throat while vacationing in London some years back.
"I was getting really sick, so I went over to the medical clinic near where I was staying. A doctor saw me right away, did an examination and prescribed antibiotics, which I got at the dispensary right on the premises. The whole thing took maybe 40 minutes, and my total cost was something like $2.50 for the pills. And I was a foreigner! No questions asked, no identification to show, I just signed in. I was sick, so they treated me."
It's experiences like Joanie's that change Americans' minds about universal health care. What? No preliminary questions about payment? No paperwork? No cost? It makes you want to tip the doctor.
Britain's National Health Service (NHS) has been drawn into our own so-called debate in the most curious ways. Opponents of reform here have made the NHS a frightening caricature, the Ghost of Christmas Future if Congress adopts even modest changes to our non-system. They thought that the Brits' frequent complaints about the NHS for its acknowledged inadequacies was a sure sign they're ready to ditch it. But they got an unexpected reaction from across the Pond: Citizens were outraged at the exploitation and embarrassed for America's callous treatment of its sick. Despite its problems, they are fiercely loyal to their system. Even the leader of the Conservative party, David Cameron, last week declared forcefully that the NHS would be strengthened, never abolished.
What brings about such adamance in a country that's not only not socialist but that has privatized many other government entities over the last three decades? Perhaps it's because, like our Social Security system, the NHS was instituted in a time of crisis, after World War II, a living symbol of the cohesiveness that brought the country through the war. It removed a Dickensian social scourge and affirmed British dignity as a civilized people. After 60 years, universal health care in the United Kingdom is a given; it's part of the national identity.
You'd think that the U.S., so close to the U.K. in attitude and outlook, would come to see it this way too. Aren't we the most generous nation on earth? What is it about health care that has made it the hot-button issue, even more divisive than war?
Given the widespread dissatisfaction with skyrocketing costs and denials of coverage, the time seemed ripe for a real shift. Yet the same sorry arguments that have been used since Harry Truman's time are de-wheeling the reform juggernaut: socialized medicine and higher taxes. "If Barack Obama and the Democrats get their way," runs a Republican National Committee radio ad, "the federal government will make the decisions about your health care. And their plan costs a trillion dollars we don't have." Whether or not these assertions have anything to do with the actual proposed legislation is almost beside the point. The G- word and the T-word still cause inflammation of that little Darwinian lobe in the collective brain that evokes the self- reliant pioneers and the self-made John D. Rockefeller. No matter that it's insurance companies that now make your health-care decisions and that they're the ones that are taxing you; once the fever starts, the nation becomes delirious.
This could have been stopped.
As the history of effective leadership has shown, it takes a clear vision, a forceful word, and an iron will to dampen inflammatory rhetoric and rally the country around a cause.
Many of us thought this was what Obama was about. Remember "CHANGE"? "HOPE"? "YES, WE CAN!"?
Well, ah ... maybe we can.
Obama's problem with health care is that he thought he could apply the principle of dialogue, one of his most attractive and effective features, to achieve reform. Right after inauguration, he got all those health-policy wonks and insurance/drug execs around a table and they all came out smiling. Then he threw the ball to Congress, somehow presuming they'd play as a team to craft bipartisan legislation to his liking, instead of sending down a bill himself. The first hundred days have turned to 200, those executive smiles hover over the Capitol like the Cheshire cat's, the radical right saw the door wide open to bring him down, and now it's a town-hall free-for-all. Couldn't he see this coming?
The extent to which Obama has lost control of the issue was no better illustrated than by his exchange with the college student in Grand Junction, Colo., last Saturday, who asked him how private insurance could ever expect to compete with a government-run "public option." All he could say was, "This is a legitimate debate to have."
College kid wins. FDR turns in grave.
Rather than taking on the insurance/drug establishment (the correct answer to the student question is: "You're exactly right, and that's why we want it."), he's not only let them in the game but let them call the shots. And rather than taking on the ultra- right by identifying their smears as plain old lies, he tells us they're just "differences of opinion."
Remember Chicago on election night? Remember Inauguration Day? Obama once had the momentum to make health care a national imperative, a part of our identity, as it is in Britain.
No vision, no word, no will: No more.