Cries of Crisis: Rethinking the Health Care Debate

Introduction: Constructing the Health Care Crisis

1 T H E L A N G U A G E A N D I M A G E R Y of a health care crisis are now firmly embedded in contemporary politics and popular culture. For decades, warnings of an emerging crisis provided a rationale for widespread changes in provider payments, medical malpractice claims, and eligibility for public health insurance programs. Crisis talk focused public attention on the need to reform the health care system, underscoring both the severity and the urgency of the policy challenges facing decision makers. Advocates of reform turned to the same familiar narratives each time proposals for reform appeared on the policy agenda. As the New York Times noted in 1993, “Fired by a sense of crisis, a majority of Americans say they are willing to accept substantial changes in their health-care system, including government price controls, new taxes, and longer waits for non-emergency appointments.” This diagnosis underscored the need for fundamental reform rather than “Band-Aid” solutions. As abc News warned viewers a decade later, this crisis “threatens nearly every city, town, and village in America. The danger is our health care system and what it’s doing to people without insurance.”1 Dire warnings of impending collapse are now so commonplace in news coverage, political campaigns, and popular culture that it seems odd to describe the health care system in any other way. The insecurity created by the health care crisis in America gnaws at the American family and at the deepest roots of our society. —Leonard Woodcock, Committee for National Health Insurance, quoted in Harold Schmeck Jr., “Panel Asks National Health Insurance,” New York Times, July 8, 1970 There is no denying our system is broken. Millions of Americans struggle each day because they do not have the coverage they need. . . . The United States is home to the finest medical professionals in the world. These professionals are on the front lines of the crisis, witnessing the failings of our country’s health care system first hand every day, as ever more Americans suffer physically and financially. —Senator Max Baucus, “Doctors, Patients, and the Need for Health Care Reform” i n t r o d u c t i o n constructing the Health care crisis 2 c r i e s o f c r i s i s To date, the meaning and significance of the health care crisis remain largely unexplored; reformers use the term in a variety of ways and assign different, often conflicting, meanings to it. Language is significant in debates over health care reform because the labels used to describe policy problems are not neutral. Just as patient narratives are vital to accurate clinical diagnoses, policy narratives shape public views about the state of the health care system, leading to specific diagnoses and policy prescriptions. Drawing upon a growing body of work on the political uses of language, this volume embraces a narrative approach to the study of health policy.2 My goal is not to produce a comprehensive rhetorical history of health care reform, but rather to explore the various meanings attributed to the health care crisis . This book raises important, yet often unasked, questions for advocates of health care reform. How did the health care crisis become a part of our common vocabulary? How did its meaning evolve over time? What are the policy implications of describing the health care system using the language of crisis? As an organizing concept, the language of crisis shapes how policy makers , providers, and the public think about the health care system. The health care crisis is a potent and enduring political symbol, but crisis narratives offer an oversimplified, and ultimately incomplete, story of what ails the American health care system. Crisis talk captures popular discontent and anxiety about changes in the health care system and the larger economy. In the end, however, narratives of crisis represent a flawed strategy for supporters of health care reform. The rhetoric of crisis generates much heat in health policy debates, but it ultimately sheds little light on what to do to fix the system . Upon closer examination, the concept of a health care crisis means so many different things to so many different groups that it has ceased to have any shared meaning at all. Crisis narratives suffer from internal inconsistencies that undermine their credibility. First, a forty-year crisis is an oxymoron. The problems plaguing the American health care system are chronic, not acute, conditions. Each time...