by Dan Munro
First posted on Forbes 8/28/2013
Today marks the 50th Anniversary of the “March on Washington for Jobs and Freedom.” It’s often referred to as the Great March on Washington – or just simply the March on Washington.
It was from the steps of the Lincoln Memorial looking toward the Washington Monument that Martin Luther King, Jr. gave his now famous “I Have A Dream” speech to a crowd of about 200,000 – 300,000. He was number 16 on the official agenda (here) that included 18 speakers – but he was effectively the last and only memorable orator of that day.
The speech (here) was both definitive and historic – with many sweeping phrases, themes and quotes. But Dr. King had an entire repertoire of phrases and memorable quotes. The actual phrase – “I have a dream” – was often used in other speeches and sermons by Dr. King. In fact, he openly debated – and was actively advised against using the phrase itself (too “preachy”) – but the selection and use for that day was ultimately his choice. He would be gone in less than five years from that delivery.
A lesser known quote (and not a part of Dr. King’s speech that day) is this one from a little over four months before the March on Washington:
“Injustice anywhere is a threat to justice everywhere.” Martin Luther King, Jr. – Letter from Birmingham Jail, April 16, 1963
Connecting the theme of injustice to healthcare appeared a little less than 3 years after the March on Washington:
“Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” Martin Luther King, Jr. – Second National Convention of the Medical Committee for Human Rights – Chicago, March 25, 1966
He’s right – on both counts – and we know it.
Sadly, we haven’t made much progress on our healthcare injustice in the intervening years. Today we have roughly 50 million Americans without healthcare insurance – and roughly another 40 million that are (arguably) underinsured. Whether or not healthcare expenses are the leading cause of personal bankruptcy here in the U.S. may be up for debate. The fact that they are a significant portion isn’t.
That’s not only an injustice – it’s an injustice at scale.
At the CommonWell Alliance announcement earlier this year (here), Jonathan Bush said:
“I think the biggest problem with healthcare today is not its cost – which is a big problem – but for all that money – it’s not an expression of our humanity.” Jonathan Bush – CEO, President and Chairman –athenahealth ATHN -0.06%
He’s right too – and we know it.
The Affordable Care Act – President Obama’s signature legislation – is scheduled to relieve some of the backlog – but not all of it. Beyond the individual mandate to buy healthcare insurance, individual states are still left to decide for themselves whether or not they will support and fund another key component of the ACA – Medicaid expansion. Many will – but some won’t.
Many doctors – primary care and specialists alike – have walked away from taking Medicaid patients – and some are now walking away from Medicare patients as well. As healthcare providers, the economic realities have made it increasingly more difficult to support these lower classes of healthcare citizens. It’s quickly becoming a form of charity care. Like all of charity, it’s always and entirely subject to the mercy and capacity of the charitable. Like emergency or triage care – it’s a charitable attempt at healthcare. But it’s not the full measure, promise or dignity of healthcare – and we know it.
There is a solution called “universal coverage” whereby everyone is extended the civil right and dignity to healthcare. Every other industrialized country (with a formal healthcare system) has adopted universal coverage as the very foundation of their healthcare system. So why haven’t we?
In a single word – fear – which is arguably based on or fueled by three strong beliefs:
1) A false assumption (with big political support) that a system based on universal coverage is the same thing as single payer, or Government run healthcare. It isn’t. Germany is a great example of a healthcare system that is both universal coverage and multi-payer. Playing into the politics of controversy and discord, however, it serves well to fuel the fear that universal coverage is “Government-run” healthcare which is known to be vastly inferior, grossly inefficient – and forever shackled to long waits, huge bureaucracies and the final of all personal indignities – death panels.
2) An attitude and culture of what’s loosely known as American “Exceptional-ism.” There is simply no other country on planet earth that can teach us anything. Our entire raison d’être is to be the world’s beacon of shining success – in freedom, democracy, capitalism – in fact, pretty much everything.
3) A fiery and fierce independence that supports the myth that literally anyone – through hard work and determination – can rise out of any poverty and become rich and prosperous. We salute, praise and deify everyone who does. But there’s a dark side to this myth. Anyone who doesn’t isn’t working hard enough – or doesn’t have enough determination. In effect, they’re a loser – and nobody wants to pay for the healthcare of those losers.
Added together and through the years, these false fears and beliefs have contributed to our runaway healthcare system. Today, the National Healthcare Expenditure (NHE) for Team USA is $3.5T per year – and growing at about 5% per year – for as far as the eye can see. It has resulted in this chart – which is now a global embarrassment and national emergency.
The hope – for some an actual prayer – is that the Affordable Care Act will significantly alter this course. I don’t believe it will – or can – because in all of its carefully crafted legalese, its only real function is to reduce the number of uninsured. Not eliminate the number of uninsured – but reduce the number (without dramatically increasing the NHE). In effect, its legislation around the edges – not at the core – and we know it.
“This is no time to take the tranquilizing drug of gradualism.” Martin Luther King, Jr. – March on Washington, August 28, 1963
The ACA’s “gradualism” will continue to force the “cost-shifting” of healthcare delivered to millions without insurance – or millions more who remain underinsured.
Service sector employers will actively pursue and find ways to avert and avoid the added cost. They always do. Providers will find ways to avoid treating Medicaid or Medicare patients. They always do. Medical device manufacturers and pharmaceutical companies are actively pursuing ways to avoid their tax. They always do – and we know it.
I actually believe we’ll get to universal coverage – and not because of any economic necessity – but because of this quote – even closer in chronological proximity than Dr. King’s.
“You can depend upon the Americans to do the right thing. But only after they have exhausted every other possibility.” Unidentified Irishman (as referenced in a 1970 U.S. Congressional Hearing – citation here)
We’re still busy exhausting every other possibility. We know that universal coverage isn’t single payer and we know it’s the right thing to do. So did Dr. King – 50 years ago. I just hope it doesn’t take another 50 years. At this rate – it just might.