Academic journal article American Journal of Law & Medicine

The Crisis of Democracy in Healthcare: An Introduction

Academic journal article American Journal of Law & Medicine

The Crisis of Democracy in Healthcare: An Introduction

Article excerpt

The historic moment on March 23, 2010, when President Barack Obama signed the Patient Protection and Affordable Care Act (“PPACA”) into law, was quickly and definitively overshadowed by a rush to repeal the legislation.1 Conservative legislators opposed the law 2 despite the fact that millions of Americans lacked healthcare coverage and could not afford to pay for medical visits.3 Reports linking unpaid, expensive medical bills to Americans' filing for bankruptcy were unfortunate, but not enough to forge bipartisan support for healthcare legislation that would benefit working and middle-class Americans.4 Healthcare reform seemed more illusory than real. Yet, this was not a new problem.

Efforts to break through legislative gridlock blocking healthcare reform and tackle the slippery task of mandating health coverage for all Americans date back decades. Obama's crowning accomplishment was a feat attempted, but never quite achieved during any prior administrations, dating back to Roosevelt.5 With the exception of President Lyndon Johnson signing Medicare legislation into law,6 health reform on the scale of the PPACA had never before been accomplished. Yet, neither Obama's efforts nor the subsequent legislation advanced without controversy. In fact, pushback over healthcare reform reached fever pitch in Congress before any semblance of potentially viable legislation emerged.

In the months leading to Obama's signing, doctors, pundits, scholars, and even members of Congress were doubtful about legislative enactment of healthcare reform. Indeed, the national deliberations on healthcare reform mired in partisanship, reinforcing deeply entrenched political divides.7 By some accounts, the political divide not only rivaled, but far exceeded the political rancor in Congress during the drafting of civil rights legislation of the 1960s.8 To some, it was not clear whether Congress was more divided or Obama less adroit and nimble than Johnson.9 Republicans threatened to filibuster the legislation,10 and Democrats coalesced, attempting to refocus Americans' attention from the mortgage and unemployment debacle back to health insurance.11

For both parties, the risks were high. On one hand, a failure to achieve some measure of healthcare reform could reveal the Democrats as incompetent and incapable to fulfill a key component of their promised legislative platform—while holding a majority in the Senate.12 On the other hand, the stakes for Republicans were a bit more complicated and nuanced: crush the legislation or use the reform efforts to defeat the Democratic Party in mid-term elections.13 If measured by results, it appears the latter prevailed.

Examples of fiery, inaccurate propaganda about the PPACA abounded and evidence of its persuasive appeal can be traced to polls conducted by the Kaiser Family Foundation, the Wall Street Journal, the National Broadcasting Company (NBC), and other news and polling organizations.14 Former vice presidential candidate and Alaska governor, Sarah Palin's claimed, “the America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's ‘death panel’ so his bureaucrats can decide.”15 Palin concluded, “based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care,” panels would decide whether Americans lived or died.16 This was unfounded and untrue, but it received enormous media coverage, including Governor Palin calling healthcare reform, “downright evil.”17 This type of rhetoric was emblematic of the strategies invoked to challenge and defeat the PPACA.

And, it worked. The death panel rhetoric convinced many Americans “that the law ‘allowed a government panel to make decisions about end of life care for people on Medicare,’” according to Drew Altman, CEO of the Kaiser Family Foundation. …

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