Senior woman with walking problem, wheelchair in background uninsured 2048 x 1365

Maybe the uninsured could learn something from Egyptians and the Arab street. At a time when landmark health reform granting most of the uninsured access to medical care for the first time in their lives is being seriously threatened, protests by the uninsured themselves are nowhere to be seen.

In 2009, a staggering 51 million Americans from every walk of life and every corner of the nation had no health insurance. The Urban Institute estimates that 400 of them die each week due to lack of access to care. However, instead of pouring into the streets to protest when an activist judge calls the health reform law unconstitutional or conservative ideologues threaten to cut off funding, the uninsured leave the loudest push-back to (well-insured) political partisans.

This quiescence on a basic human right to care contrasts sharply not only with those braving tear gas and truncheons in Cairo. In this country, merely mentioning gun control fuels a firestorm of protest by firearms supporters. Gay marriage has mobilized liberals and libertarians alike over the “freedom to marry.” The children of undocumented immigrants have dared arrest and deportation to plead publically for the right to become American citizens                          How many of the uninsured are willing to endure that?

More than one in six Americans is now uninsured. Where are they? The few exceptions to this rule show how much their faces and voices and names are missed. At a hearing by Sen. Tom Coburn (R-OK) in 2009, a sobbing, middle-aged woman confessed she couldn’t afford care for her brain-injured husband. Coburn, a physician, glibly responded that “the idea that government is the solution to our problems…is very inaccurate.” The partisan Republican crowd applauded, in an exchange captured by CNN, but the reaction of ordinary Americans was far more negative.

An estimated 690,000 Oklahomans have no health insurance. Why were so few in the room? Why did hundreds of them not pour into Coburn’s office the next day? Why do they not continue to tell their stories?

Like the ruling elite in Egypt who genuinely don’t comprehend the problems of the average family, polls going back more than a decade show that Republicans are more likely than Democrats to genuinely believe that the uninsured really don’t have any problem getting good-quality care.

Yet among the less partisan, there’s a readiness to reconsider. Personal experience plays a key role, an analysis in Health Affairs concluded, with those who are younger, poorer and female being more sympathetic. The elderly, whose rich Medicare benefits have shielded them from the brutal effects on medical care access of the weak economy, “are not cognizant of the problems faced by the uninsured,” the article noted. A just-released poll shows a majority of the American public does not back repeal or ending funding, but how the issue is framed is critical.

Put plainly, the political and legal peril in which health reform finds itself is directly attributable to the failure of the uninsured to visibly advocate on their own behalf. Those without health insurance have allowed a civil rights issue of guaranteed access to medical care to become a referendum on Big Government rather than a test of basic human compassion for brain-damaged husbands. And, even more ironically, have left the heavy lifting on lobbying against repeal to the big insurance companies of the world such as Aetna, Humana, UnitedHealth Group and WellPoint

Worse, while the prestigious Institute of Medicine characterizes the consequences of a lack of access to care as “needless illness, suffering, and even death,” it is Republican physicians in Congress brazenly lead the effort to repeal care coverage.

By coincidence, there are about the same number of elderly on Medicare as there are uninsured. Egyptians understand the power of an aroused populace. Do the uninsured? In Red States and Blue States in 2012, there will be Congressional districts and senatorial races up for grabs and a contest for the presidency featuring a man who made a historic effort on their behalf. Will Republicans whose party has never put forth a serious proposal to provide access to care for all suffer any consequences at the ballot box from turning to the sick, the scared and the suffering with a curt, “Government is not the answer.”

Or, perhaps, have conservatives been right all along that liberals have vastly overestimated the scope and impact of this problem?

If there’s anyone who understands the power of individuals coming together to make demands on their own behalf, it is a black man who rose to the presidency from being a community organizer on Chicago’s South Side. Yet rather than rally the uninsured to present their case as people just like us, President Obama has allowed Republicans to frame the issue as a debate over the Commerce Clause of the U.S. Constitution.

Fortunately, the fight to retain actual funding for the expanded coverage in the Affordable Care Act is just beginning, with “aggressive” hearings scheduled by Republican committee chairs in the House and by opponents in the states. It is a battle that Democrats can win only if Americans genuinely understand that it is the health and lives of their friends, neighbors and relatives that is at stake. For that to happen, those whose lives are most intimately affected must first stand up for themselves.

Michael Millenson
Michael L. Millenson, president of Health Quality Advisors LLC, is a nationally recognized expert on making American health care better, safer and more patient-centered. Michael is the author of the critically acclaimed book, Demanding Medical Excellence: Doctors and Accountability in the Information Age, and he is also an adjunct associate professor of medicine at Northwestern University’s Feinberg School of Medicine. Earlier in his career, he was a health-care reporter for the Chicago Tribune, where he was nominated three times for a Pulitzer Prize. A respected presence in health policy and strategy, Michael has lectured at the National Institutes of Health and the Harvard Business School and served as a faculty member for the Institute for Healthcare Improvement. He has testified before Congress and written for publications ranging from the British Medical Journal and Health Affairs to The Washington Post and Michael has consulted with policymakers and with a broad range of clients from all segments of the healthcare industry, providing services ranging from strategic planning to develop specific tools to improve care. He has served on the advisory board of several healthcare start-ups and currently serves in an advisory capacity to the American Journal of Medical Quality and the Lundberg Institute.

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