100 years in the making

That was a rough 100 years.

And the past year of debate on healthcare reform seemed like all 100 wrapped into one. In fact, if you look at the chronology on preceding pages, you will see that what has happened since 2009 in many ways encapsulates the U.S. reform war that has raged since the early 20th century. The intense partisanship and the cries of “socialized medicine” and the “death of freedom” are like reruns of a bad soap opera.

One of the many ironies of the latest episode is this: The Democratic bill that was signed into law last week was very similar—if not more moderate—than the plan proposed by President Richard Nixon in the 1970s. It incorporates ideas floated by conservative thinkers in the 1990s. It is similar to the plan now operating in Massachusetts, even though the man who signed the measure, former Gov. Mitt Romney, has been trying to run away from it. In short, the national reform bill that spurred all the bitterness contains lots of Republican DNA and might have been enacted 40 years ago if it weren't for the personal problems of Nixon and the late Sen. Edward Kennedy and the distractions of a nation in turmoil.

We shall see if this law remedies what ails the U.S. healthcare system. One problem is that it leaves the nation with an overly fragmented scheme and overlapping realms of coverage. The patchwork of Medicare, Medicaid, veterans care, employer-sponsored care, etc., will remain. Most estimates of the bill's impact suggest that a few million people will still go without coverage.

And we shall see if the concessions made in drafting the legislation were too costly. What helped pass this law was the cooperation of many segments of the healthcare industry. They calculated that the long-term benefit of some 30 million additional insured people outweighed the drawbacks. That was in contrast to previous attempts, most recently the Clinton plan in which insurers, providers and drug companies staged a re-enactment of “Murder on the Orient Express.” This time, according to the Center for Public Integrity, more than 1,700 companies and organizations hired more than 4,500 lobbyists—eight for each member of Congress—to influence 2009 legislation for better or worse.

Still, and for all the potential problems, this law is at least a good start. It sets the nation on a course toward universal coverage and attempts to bring some rationality and economic efficiency to a healthcare system in name only. The measure should end the cruelty of our current insurance practices such as denial of coverage because of pre-existing conditions and expulsions of people who get sick.

The debate on the legislation to achieve these goals often did not bring out the best in America, now or in the past. Appeals to fear and to greed—you're going to have to pay for some deadbeat to get healthcare—were hardly flattering.

In his book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, which should have been a must-read for all Americans during this debate, journalist T.R. Reid recounts an explanation of the French health system's emphasis on equal access offered by one of its doctors: “It would be stupid to say that everybody is equal. Some are rich and some are poor. … But when we get sick—then everybody is equal. Everybody must have an equal right to the best medical treatment we can provide. … Surely, that's the rule of healthcare in every country.”

For at least 100 years, it hasn't been the rule here. With the new legislation, maybe it will be soon. Because surely, we're all Americans, aren't we

What do you think?