The vote in the House of Representatives to adopt the Senate-passed health reform legislation, as modified by a separate corrections bill, has been rightly labeled as "historic" by many observers. On this, there is little disagreement. But the debate in the House of Representatives showed two opposite views of the history being created. For Democrats, it an historical achievement on the par with adoption of Medicare, the Civil Rights Act, and Social Security, writes E.J. Dionne in the Washington Post. For Republicans, it is an historical calamity that will inexorably lead to government-run health care, and "ruin" for the country, according to House minority leader John Boehner (R-OH).
I think we are too close to events - and emotions are running way too high - to determine how historians will rule. What I do know is this. At least since the early 1990s, the American College of Physicians has championed the need for universal health insurance coverage. The "other" internal medicine organization, the American Society of Internal Medicine, which merged with the ACP in 1998, also advocated for health coverage for all Americans, although it differed with the ACP on some specifics on how best to achieve it. (Disclosure: I was the senior government affairs person for ASIM before taking on this role for the combined merged organization, and I remember sparring with the ACP over some cost controls in the Clinton health care plan.) The point, though, is that internists - perhaps more than any other group of physicians - have long been on the side of providing all Americans with health insurance coverage.
I believe that history will show that ACP had a major role in bringing about enactment of the legislation, and that it was able to influence it to incorporate many of its own key policies.
This morning, I received an email from a former Senate staffer, who had worked with ACP several years ago in crafting legislation based on ACP's own "seven year plan" to provide all Americans with access to coverage. This is what he had to say: "Throughout this process, I kept thinking that much of the framework was much like the old ACP bill and that you should be proud of much of that!"
I also believe that history will show that the ACP's Board of Regents and Board of Governors showed tremendous courage in continuing to stand behind reforms to provide Americans with access to affordable coverage, based solely on how the legislation advanced ACP's policies. They did so despite unrelenting partisan and political pressure, and with a keen awareness that a segment of ACP's membership would likely be opposed to the legislation.
And I hope that history will show that I was able to help the organization achieve its vision of coverage for all.
Yet today, my pride in ACP's contribution to yesterday's historic vote is tempered by how polarizing, for the country and for the medical profession itself, the debate has become. Agreeing in abstract that everyone should have coverage is one thing. Achieving consensus on how to accomplish has proven to be a far harder thing. Unfortunately, the debate too often has veered from respectful disagreement about the means to ad hominine attacks on those who see things differently. I hope that we are able to soon get back to a respectful dialogue about how best to provide access to health care, rather than demonizing each other’s views and motivations, but I have my doubts.
And let's be honest. I don't know for sure how the whole thing will turn out. My heart and mind tells me that historians will view it as a tremendous step forward in providing all Americans with access to affordable care, but I am aware that they could decide it was a mistake. I wish that opponents also would be humble enough to acknowledge that they also can't see the future and that they might be wrong when they say it will lead to the "ruin" of our country.
Faced with a choice with uncertain results, ACP supported the legislation for the right reason, to help patients get access to affordable health care.
Today's question: Do you think ACP has been right to advocate for health coverage for all?