“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
These were the words spoken by the Rev. Dr. Martin Luther King, Jr. on March 25, 1966, in a speech before the Second National Convention of the Medical Committee for Human Rights. In the 50 years since this speech, we have come a long way as a nation; yet his dream of a land of equal opportunity with guaranteed access to quality health care remains unrealized.
As a family physician, I understand first-hand the barriers and challenges that have existed and continue to exist in our health care system — problems with access, quality, costs, and equity. In one of the wealthiest countries in the world, too many people face barriers to care due to lack of coverage, lack of affordability, or geography.
Uneven health care quality makes us a country where some patients receive some of the best care, but millions still suffer from inadequate care, inappropriate care, or preventable complications. Overall, we pay more but don’t experience better health outcomes. Think about it: Would you pay more for a leaky hose or for cable television service that only works on certain days?
In addition, for many communities, there are persistent disparities. If you live in a low-income urban or rural community, your health and your health care are likely to be worse. In 2009, prior to the Affordable Care Act (ACA), there was consensus across political lines that the status quo was unacceptable and unsustainable.
The ACA is not perfect. But, contrary to partisan political rhetoric, our health care system is much better today than it was six years ago by any objective measure. I know about the many persistent challenges — affordability, high pharmaceutical costs, too few primary care providers, and too much attention to treatment and not enough to prevention.
But I also see improved access and health in the newly insured and the overwhelming data from across the country showing the transformative — yes, transformative — gains being made.
In less than seven years, the ACA has provided affordable insurance options for low- and middle-income working families, young adults who can remain on their parents’ plans, and people with pre-existing conditions who were previously denied coverage — lifesaving coverage to over 20 million Americans who were previously uninsured.
Think about your neighbor or family member or co-worker who had breast cancer or lives with depression or a disability. People living with mental health or substance use disorders are now guaranteed parity. Women are no longer discriminated against with higher insurance rates because of their gender. Preventive services like screening tests for diabetes or HIV, colonoscopies and mammograms, reproductive health care and contraception are now available without deductibles or co-pays.
Quality is improving in hospitals and clinics across the country. Instead of hospitals making higher profits when patients experience preventable complications because they can bill for additional services, they are now penalized — aligning payment with safer care and better outcomes. Innovations and new models of care demonstrating better outcomes and lower costs are flourishing across the country.
The U.S. Congress has just passed legislation setting the stage for ACA repeal. But experts, providers, patients, health system leaders, and health insurers across the political spectrum understand that repealing the ACA without a comprehensive replacement plan is reckless and risky for all involved. Destabilizing the health care system puts millions of Americans, including those with employer-sponsored plans, at risk financially and in terms of their health coverage and care.
It is time for our political leaders on both sides of the aisle to demonstrate the mature, thoughtful leadership that our country needs. Our health care system needs continued improvement, but imploding the current system without a carefully planned and vetted replacement is both dangerous and irresponsible.
Fifty years after Dr. King’s speech, inequality and injustice in health and health care continue to affect the lives of too many in our nation. As we remember Dr. King on the anniversary of his birth, may his words be a reminder of our shared humanity and the necessity of health care and opportunities for health for all. May his memory be an inspiration.
Harry J. Heiman, MD, MPH, is director of health policy for the Satcher Health Leadership Institute at the Morehouse School of Medicine. He is active in Georgians for a Healthy Future and the Georgia Academy of Family Physicians.