And Health Care For All

This month marks the release of Sicko, the latest documentary film by Michael Moore, which lambastes the state of American health care. Sicko highlights the fact that although the U.S. spends more on health care than any other country, its citizens have a lower life expectancy and higher infant mortality rate than most nations in the Western world. In a particularly notorious scene that provoked an investigation by the federal government, Moore accompanied a group of 9/11 rescue workers to Cuba to petition for the health care that they could not afford at home.

The limited accessibility of good health care in this country has long been a matter of concern. In “Medical Education in America” (June 1910), educator and reformer Abraham Flexner addressed the fallout caused by deficient medical training during the 19th century. The unregulated transition from an apprenticeship system to a system in which aspiring doctors were trained by independent and often inept medical colleges, he explained, had left much to be desired. While the new education system had birthed some “competent and humane physicians,” it had also, he pointed out, turned loose quite a few “rapidly-made doctors” who simply did not make the cut. "If the sick are to reap the full benefit of recent progress in medicine," he argued, "a more uniformly arduous and expensive medical education is demanded."

Two decades later, in “A Cure for Doctor’s Bills” (October 1930), Evans Clark took issue not with physicians’ knowledge base but with the nation's disorganized system of administering health care:

Uncounted numbers of men and women in the United States are suffering from the present chaos in medical service.… It is not the science of medicine from which we suffer, but rather a seriously faulty organization of medical service. Our complaint is against the system, or the lack of it, by which we are served with medical care.

Clark argued for the creation of a unified national medical program divided into “medical guilds” that would ensure consistency of treatment and enable all citizens to reap the benefits of medical innovations.

Three years later, William Trufant Foster, the founding president of Reed College, made a case for a much more comprehensive program to improve American health care. In “Dollars, Doctors, and Disease” (January 1933), he lamented how “many millions of men, women, and children suffer from preventable diseases,” and proposed that the United States provide health care on the same basis as education.

The science of preventive medicine has made marvelous advances in recent years and tens of thousands of competent physicians are eager to use their new knowledge and their idle hours to save humanity from needless suffering.

Evidently, the problem of providing adequate medical and dental care for all the people is in one essential the same as the problem of providing adequate food, clothing, shelter, and transportation. The main question is how we are to enable the people to pay for the commodities and services which already we are fully able to provide. Under present conditions, the best medical care is available, where it is available at all, only to the very poor and very rich.

Foster’s concern about everyday Americans' lack of access to medical treatments also rang true to physician and Harvard Medical School professor Channing Frothingham. In “The Health of the Nation” (February 1947), he weighed the relative merits of two possible methods for covering the cost of medical care: insurance and public medicine. He cited both a low enrollment rate and incomplete medical care as hindrances to insurance’s success:

How shall we extend this insurance program so that it will be available to all but the really indigent? And how shall we provide comprehensive high-quality medical care, including preventive medical procedures, early diagnosis, and treatment for all?

In September 1960 Osler L. Peterson, another Harvard Medical School professor, picked up the debate in “How Good is Government Medical Care?” Peterson contended that the intense focus on how to pay for health care “obscures the crucial fact that we are struggling not with a fiscal problem but with a human problem.” This “dangerous attitude,” he argued, obscured the crucial point that the most basic function of health care is to provide for others.

Although Peterson shared Michael Moore's fundamental goals—to humanize the health-care debate and learn from the experiences of other nations—he cautioned against oversimplifying the issues at hand. At the time his Atlantic article appeared in print, Congress was preparing to vote on yet another health-care reform bill, but Peterson warned his readers not to seek a legislative quick fix. His concluding observation, made nearly 50 years ago, might serve us well today:

Rational answers will not come from hastily considered legislation in an election year, though that is the way the process usually begins. If the liberal is a man who dislikes change but recognizes its necessity, then he and his legislators will need the time to plan what must be changed, the courage to leave some things unchanged, and the wisdom to tell the difference.