The midterm elections seem to be all about health care. Republicans spew venom toward Democrats for passing the reform bill. Democrats distance themselves from the legislation.
If Lyndon Johnson had been alive on March 24 when President Barack Obama signed the Patient Protection and Affordable Care Act into law, he would have remarked from experience that the battle for health care reform had only begun.
We remember the July 30, 1965, signing of Medicare into law as the smooth establishment of a popular program. But that’s not at all how it went down. The program was nearly destroyed by doctors and hospitals threatening to boycott it.
Calling it “socialized medicine,” the American Medical Association waged war against the program before and after it became law, with doctors warning their patients against it, thus threatening the public support that Johnson needed.
Johnson outmaneuvered them by giving the AMA a seat on an advisory council that oversaw rules and regulations, one of which was setting physician fees, and the doctors acceded. Thus began wealth among physicians.
Many hospitals, especially in the South, were segregated and threatened to boycott because of the provision that hospitals be integrated. Johnson allowed no compromise and set up a battle council.
He had Vice President Hubert Humphrey telephone mayors to pressure resistant hospitals. In the final weeks before Medicare’s beginning, the hospitals integrated rather than lose federal dollars. LBJ sent hundreds of inspectors to ensure hospitals receiving Medicare funds were indeed integrated.
Thus began Medicare.
Fast forward to 2010. On the campaign trail for president, Obama got his strongest applause when he spoke of insuring all Americans and keeping insurers from denying coverage based on pre-existing conditions. The brightest minds in health care drafted a plan that would achieve those results.
The bill enjoyed the support of organized doctors and hospitals. Insurance companies were the holdout. When the public option was ultimately dropped in favor of insurance exchanges, the companies jumped on board, and the bill was passed.
Unlike the interest-group battle over Medicare, this law is threatened by party politics. The ads from this election cycle show how prominent the issue weighs and how ugly the rhetoric can get. The fact that the provisions in this law kick in more slowly than Medicare leaves it even more vulnerable to attack.
If the conservatives regain power, they’re not likely to repeal the law. But if they strip away critical, easy-target elements — such as the requirement that uncovered individuals be required to buy at least a basic policy and the subsidies to make sure they can afford them and/or the requirement that large employers provide health benefits — then coverage for the uninsured will be effectively gutted. With 21 states, including Texas, suing to stop parts of the reform, a showdown looms.
The major objection is the insistence that it is unaffordable. When Medicare became law, health care represented 6 percent of U.S. economic output. Today, the figure is an unsustainable 18 percent. Our health care system pays for the quantity rather than the value of care, and it should be clear to everyone that without fundamental change, the same trend will continue.
Included in the overhaul is a Center for Medicare and Medicaid Innovation where local hospitals can do what the hospital where I work did. Within six years, we reduced our term infant birth trauma from 0.3 percent (half the national average) to 0.01 percent. We did this by bundling best practices and improving interdisciplinary communication in the delivery room.
In 2003, we billed $1.5 million for birth trauma. Last year, we billed $25,000. While representing a loss for our hospital, it’s a huge savings for Texas, which foots much of the Medicaid bill.
Rather than a government takeover of health care, the law frees communities and local health systems from existing payment rules and allows them to experiment, as my hospital did, for ways to deliver better care and ultimately lower health care costs.
The midterm elections seem to be all about exploiting the down economy and taking aim at those who courageously cast a vote to overhaul an unsustainable system. They should not be targeted and punished. People would do well to remember the fury and acrimony that surrounded the passage of Medicare.
This law is designed to insure nearly all Americans while increasing the value of care. If allowed to stay intact, it may well be as momentous as Medicare.
Austin, Texas