Cries of Crisis: Rethinking the Health Care Debate

1. The Rhetoric of Health Care Reform

14 W R I T I N G I N 1 9 2 4 , Virginia Woolf declared, “On or about December 1910, human character changed. I am not saying that one went out, as one might into a garden, and there saw that a rose had flowered, or that a hen had laid an egg. The change was not sudden and definite like that. But a change there was, nevertheless; and, since one must be arbitrary, let us date it about the year 1910.”1 In a similar fashion, the way policy makers, providers, and the public viewed the American health care system shifted dramatically on or about 1969. In the span of a few short years, fear replaced progress as the defining theme in public deliberations over health care reform. Although President Richard Nixon proclaimed the existence of a health care crisis in 1969, no single triggering event—such as the OPec oil embargo in 1974 or the 9/11 terrorist attacks in 2001—defined the emerging health care crisis. Nevertheless , the shift in public sentiment was palpable, as characteristics of the health care system previously regarded as strengths were redefined as weaknesses . Policy makers and the public became preoccupied with rising costs, the future of the private health insurance system, and the stability and security of their relationships with health providers. By 1970 talk of an emerging crisis reshaped public sentiments and expectations about the health care system. The rapid shift in public sentiment raises several significant questions. Why did the rhetoric of crisis take root in the late 1960s? What led to such a dramatic shift in sentiment in such a short period of time? What political , economic, and social circumstances contributed to a growing belief that the health care system was in crisis? To understand the origins of the health c h a p t e r o n e the rhetoric of health care reform To discover our illusions will not solve the problems of our world. But if we do not discover them, we will never discover our real problems. —Daniel Boorstin, The Image Words cannot tell us everything we need to know, but they can tell us what we do not know and what must be discovered. —Roderick P. Hart et al., Political Keywords: Using Language That Uses Us t h e r h e t o r i c o f h e a l t h c a r e r e f o r m 15 care crisis in America, we must return to the period before this policy narrative became the principal lens through which Americans viewed their health care system. Before the crisis The optimism and sense of purpose that defined the “American century” were clearly evident in public discourse about health and health care in the 1950s and 1960s. Doctors and medical researchers enjoyed the trust and confidence of the public. Talk of conquering disease was commonplace. The pace of medical progress seemed to be limited only by the availability of resources to fund new research and to make new treatments and therapies available to the general public. As President Harry S. Truman declared in 1947, “There is no more important function of democratic government than to improve the health and increase the well-being of its people.” Truman urged Americans to “take action in our common purpose so that each year may bring new victories over disease.”2 The ascendance of political liberalism in the post–New Deal period also reinforced the notion that in an affluent society, more and better health care was not only possible but achievable. In this context, the principal goal of health policy was to enable more Americans to enjoy the fruits of medical progress. Speaking in 1962, President John F. Kennedy described health as “a prerequisite to the enjoyment of the ‘pursuit of happiness.’ Whenever the miracles of modern medicine are beyond the reach of any group of Americans , for whatever reason—economic, geographic, occupational, or other— we must find a way to meet their needs and fulfill their hopes.” Kennedy left little doubt that achieving this goal was within reach, and he urged Americans to “let this be the measure of our nation.”3 This powerful sense of optimism was rooted in a faith in scientific progress . By 1960, Godfrey Hodgson notes, “the doctors expected to conquer disease. There was so much publicity about the cure for cancer, the cure for heart disease . . . that people began to feel ‘it...