We hold these truths to be self-evident
"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are life, liberty and the pursuit of Happiness." These famed words written on parchment in 1776 became more tangible with the passage of the recent health-care law. In expanding coverage to 32 million Americans we approached a more equitable union where all citizens have the opportunity to achieve the fullness of life. Quite obviously, it will not solve all of the complexities of the American health system, but it does represent a credible start and investment in our collective future.
Flawed as it may be, the current law narrows the health and well-being gap between the insured and uninsured. While it is not possible to legislate good health, rather, it is possible to legislate good health policy, and recent legislation, if it has done anything, has rendered a down payment on meaningful health reform. Among its successes are aggressive insurance reforms (to the benefit of those with preexisting conditions and chronic illnesses) and widened access or coverage options for the middle class, those on the individual market and small businesses.
Though the recent health-care law seems to have started a chain of events and seized the American electorate, and to some extent sent ripples across the larger health system, equally volatile issues, such as tort, health delivery and payment reforms and aggressive cost containment measures still occupy the to-do list. On top of that, protracted roll out of benefits, industry taxes that may trickle down to consumers, the individual mandate (a boon to insurers) and a largely unscathed pharmaceutical industry, serve as a mixed bag of incidentals. In essence we have only begun to solve the health-care conundrum. Health-care nirvana, we have not reached.
Pundits and politicians will weigh through the 2010 and 2012 election cycles and beyond, whether this particular bill and the manner in which it was enacted was the right political move for the President and the Democratic-controlled Congress. Though history remains the final arbiter, I believe both had a moral imperative to act, and to dodge this otherwise momentous occasion would have been cowardly and reckless given an already bloated system.
Fortunately, there is more to health than the political bottom-line. Indeed health policy, like all policy, is limited by what is politically feasible (given social and cultural norms), in addition to structural and economic realities. Still, as the document elaborates, "Governments are instituted among Men, deriving their just power from the consent of the governed" to act responsibly on behalf of its citizens. In a nutshell health-care reform constitutes responsible action.
The overwhelmingly partisan tone of the health-care debate and the intensity of public sentiment have made it increasingly apparent, however, that health care reform is proxy for a lot more. The undercurrent of who is "deserving" is scarily palpable, Thus, the march forward must not languish in victory, but press to articulate the next appropriate steps, fully addressing the social determinants of health, prioritizing prevention and wellness efforts, and tackling health disparities.
Health will continue to be the province of individual choice and responsibility, as it should be, but our next front is health literacy and health engagement to facilitate better patient-provider relationships in both a top-down and bottom-up approach.
When it is all said and done, though we have journeyed many miles, and hit major milestones, even so we have miles yet to travel.