Dear President Obama:
As you begin your new term, no issue calls for urgent, radical change more than health care. The lack of access to quality care for tens of millions, the absence of cost controls, the discontinuity of care that results when a person loses or changes jobs, the dearth of evidence to know what treatments and therapies are effective, the imbalance in the health-care workforce resulting in too few primary-care providers — collectively these issues highlight the economic and moral imperative for securing comprehensive health-care reform.
Over the past century several U.S. presidents proposed or attempted to enact a national health-care plan. Theodore Roosevelt’s platform for the Progressive Party in 1912 advocated for a system of social insurance to protect against sickness, irregular employment and old age. Harry Truman strongly endorsed a bill in 1945 to enact health insurance funded by payroll deductions. Bill Clinton was elected to the White House with strong support for enacting major health-care reform and appointed his spouse to lead the health-care task force to craft a bill.
In each case the status quo won out because of a potent minority of groups who believed they benefit from the status quo, and to the inability of those promoting change to unite the grassroots behind a common plan. Strong, well-financed opposition by the American Medical Association, private health insurance and pharmaceutical companies and others fought back the call for change.
The combination of global economic crisis and political will to avoid further collapse makes now the time to achieve meaningful, sustainable change to the health-care system and the health of all Americans. I hope that the myths of the past decades will fade away. You have certainly heard them: We can’t afford it; we don’t need socialized medicine; we will now have rationing of care; biomedical discoveries will cease. These are all old excuses, which do nothing but preserve narrow special interests. I say we can’t afford NOT to enact substantial reforms.
First and foremost, I urge you to craft your plan with an unwavering commitment to provide for universal coverage so all people in the United States have equitable access to quality health care independent of place of residence or employment status.
Second, you will be faced with the decision on how to pay for it. I believe a single-payer financing model offers the best opportunity to achieve and afford universal coverage. Single-payer systems can be more equitable, with lower administrative costs and per capita health-care expenditures than systems using multiple payers, while still maintaining high quality, access and patient satisfaction.
Third, for universal access to become feasible, simultaneous reforms of health-care workforce policy and reimbursement are needed. We must educate and train enough primary care physicians and nurses, reward them for providing preventive and chronic care services, and coordinate the specialty care of patients in a patient-centered manner. We must be willing to commit to paying for disease prevention as well as treatment. The economic benefits of prevention, as seen by a century of achievements in public health, are astounding.
Many forces are at work to limit your ability to enact major reforms. Your recent experience in running a successful presidential campaign illustrates the importance of gaining broad, grassroots support from diverse constituencies to sustain momentum for change. The present economic crisis adds the necessary urgency to move swiftly. A slow unveiling of a plan by waffling policy experts favors those waiting to delay or derail change. Don’t worry about appeasing the opposition. With growing unemployment and uncertainty in the workplace, both employees and their employers will rally to support a comprehensive change in how we gain access to and pay for health care.
Finally, in the pre-inaugural letter to your daughters, you wrote: “I want all our children … to get good jobs: jobs that pay well and give them benefits like health care.” I would suggest that you amend that letter to state that you want all children to have the freedom to seek employment, start a new business or change careers without worrying about whether they can still access and afford health-care services. I hope that in eight years you can write them your exit letter proclaiming that while in office you signed a bill to enact health care for all people.