In Cincinnati on Labor Day, 2009, President Obama rallied the faithful in support of quality care for all at a reasonable cost to individuals and society. On September 9^th, 2009, in address to a joint session of Congress, the President not only clearly laid out what needs to be done but said he would not tolerate delay, stalling, or proposals that would increase the ballooning national deficit. The next few weeks will be critical for health care reform as the various wings of the Democratic Party, and maybe a few liberal Republicans, a vanishing species, will be lining up behind change. Even many who voted for Obama, often a feel-good exercise of supporting a person of color, are now realizing that this man is a doer and not a figure head. Mr. Obama is attempting to complete the work of one of my heroes. Let me take you back a few years.

The blueprint for change was laid out by a hard-working member of the United States Senate. In 1972, the recently elected chair of the Senate Health Subcommittee, Edward M. Kennedy, published a lengthy critique of the American health care system that rings true today and can help propel that rally for change forward. In Critical Condition: The Crisis in America’s Health Care, Ted Kennedy’s eight chapters attempted to answer the following policy questions:

1.      Should good health care cost an American everything he owns?

2.      Should good health care mortgage a family’s future?

3.      Should Americans be denied health care because they cannot pay?

4.      Should Americans seek out health care or should health care seek out those in need?

5.      Should Americans organize their health care or should the health care system organize itself?

6.      Should Americans be left to find high quality care or should the health care system guarantee quality?

7.      Should hospitals and doctors be both businessmen and healers?

8.      Should health insurance be big business?

Each question essentially asks how we are going to change things. In the chapters that follow, the health insurance industry and organized medicine are scolded and ripped into in a populist fashion. The young Senator from Massachusetts put health care back on the national agenda, following the 1965 success of President Lyndon Johnson’s signing into law Medicare and Medicaid. His book was a teaching tool to gain support for his Health Security Program, and in many ways, an extension and enhancement of Medicare, a publically financed insurance system.

Do not the same criticisms of how poorly served our citizens are by the current health care system clearly hold today? In fact, since 1972, most of the issues raised by Teddy Kennedy and the stresses for average Americans are exacerbated. Even the insurance industry and organized medicine are recognizing, rather than pushing back; they know that reforms have to come about  in risk avoidance (insurance) and  the use of ineffective interventions (medicine).

But to hold the insurance industry accountable and to keep fees down, we need to have a robust public option. It is time to put a stop to business as usual--not a stop to business models that promote effective and efficient practices that serve consumers. It is possible that legislation that calls for all-payer regulation could be the functional equivalent of a public option that can be used as a basis of competition with the private insurance plans. However, if the advocates of a robust public option back away from it they should gain something in return that would also enhance the emergence of affordable, comprehensive and continuous health insurance for everyone. This is one time in the formation of new policy when moral and economic grounds are completely compatible.

Arnold Birenbaum