Little did I realize when I decided to forgo going to synagogue on Yom Kippur 6 years ago, I would embark on a wonderful journey through our “dysfunctional political system.” Sitting in our backyard on that day, I listened to the prayer, Unetanneh Tokef (Leonard Cohen version), that asks who will die by fire who by water….who will be impoverished and who will be enriched. It resonated for me. As a practicing psychiatrist for nearly 20 years I have had an insider’s view of the US Healthcare system. It struck me there will be many who die as a result of preventable medical errors or lack of access to medical care. Medical bills will bankrupt many. So began my journey infused with the passion to help create the best healthcare system for all Americans.
My Journey to Health Reform Activism
On the fourth anniversary of the passage of “Obamacare,” I pause to reflect on the road traveled and to chart the course for moving forward. The journey has taken me from reading position papers and countless articles and comments, to an addiction to C-SPAN, to participating in numerous forums and town meetings. I’ve discovered ideas and thinkers that expanded and changed my mind. I’ve attended conferences about things I never knew existed and experienced unexpected emotional reactions. I even spent a Saturday at Independence Hall National park engaging fellow citizens about the Health of the Nation.
Prior to the 2008 election of Barack Obama, armed with a rudimentary understanding of the complexity of the US healthcare system, but perhaps hindered by naivety about the dysfunctional political system, I set out to be part of the solution. I have long believed that the attainment of the highest possible level of health and well-being is a fundamental human right and that Universal Healthcare was the right solution for what ailed the healthcare system.
Building on the UN Universal Declaration of Human Rights, I “created” a “Healthcare Bill of Rights” to promote dialogue. I outlined a prescription (Rx4Reform) for treatment that leveraged my experience as a physician. The Case of the US Healthcare System followed the structure of a medical case presentation to define the problems, provide relevant data, facilitate meaningful discussion, and draft an action plan to achieve the best outcome. Rx4Reform went nowhere. Few wanted to hear about universal healthcare, let alone actively engage in efforts to bring it about. But that all changed as a result of the election of Barack Obama.
And, Then Came Obama
It was exhilarating when president Obama chose healthcare reform as a top issue for his presidency. Former senator Tom Daschle was nominated to be Secretary of DHHS and lead the healthcare reform effort. I invited friends and neighbors to one of the more than 4000 “house meetings” in which citizens were asked to discuss the challenges of healthcare and provide solutions. Then political reality set in. Soon after President Obama took office, Daschle’s nomination was withdrawn as accusation of failing to pay taxes surfaced. Where candidate Obama railed about the influence of special interests on Washington politics, President Obama brought them to the table. It appeared they had an important role in writing the legislation that came to be known as “Obamacare.” At that time I became a passive observer of the political drama. I was virtually addicted to CSPAN, watching committee and subcommittee hearings and tuning in to “Washington Journal,” the call-in show on the weekends. Through commentary in liberal and conservative news outlets, events at the Constitution Center, and many other venues I learned of the extensive political, economics and legal issues, as they relate to the role of government and the Constitution.
A town hall meeting held at the Constitution Center had a transformative impact on me. In college I had been active in issues related to the war in Vietnam. It was a passionate period with student action challenging government policies. At the town hall, against the background of Independence Hall, I experienced the passion of citizens enraged by the government that they believed would limit their freedoms or enslave them in socialist chains. While I didn’t agree with their conclusions, the anger and passion were striking. That rage continues to energize American political life.
When “Obamacare” was signed into law on March 23, 2010, I read the entire bill. Though it was far from what I had hoped for, I was cautiously optimistic. “Obamacare” includes many provisions, particularly public reporting and transparency requirements that have the potential to improve healthcare quality and “bend the curve” of escalating medical cost. These aspects of the law are rarely publicly discussed, let alone effectively implemented.
Undeterred by the toxic political environment of the past four years, I created Citizens4Health to continue the mission to achieving the best healthcare system. We are a small group, inspired by Margaret Meade’s quote, “Never doubt that a small group of thoughtful committed citizens can change the world, it is the only thing that ever has.” We needed a road map to guide our passion.
The late Internet and transparency activist Aaron Swartz provided a path forward. In When Is Transparency Useful? , Swartz asked us to imagine groups of people coming together to tackle an issue they care about. Rather than each using data on their own, they use their particular skills to maximize the benefit of information for the public good.
We start this phase of the journey with the mission to make all Delaware Valley hospitals top hospitals. Borrowing from Swartz, we leverage and “translate” publicly reported patient safety and quality outcomes to actionable information for fellow citizens. We ask How Safe is Your Hospital? and provide a treatment plan to eliminate preventable hospital associated conditions.
Regardless how successful our efforts will be, the past few years have been remarkable for me. Most importantly, “Obamacare” led me to reclaim my role as a citizen actively engaged in creating a better world for others.