Thursday, July 7, 2016

150 YEARS OF OBAMACARE by Daniel Dawes looks at the long history of health care reform in the U.S.

"Everyone has had at least some experience with the health care system, and advocates on either side of the debate are passionate and vocal about their cause. For more than a century and a half there have been bitter struggles over advancing health care access and improving delivery of care in this country. So how did advocates of health reform and health equity in 2010 achieve the most significant milestone in United States health law and policy?"

So writes Daniel Dawes in his preface to his new classic, 150 YEARS OF OBAMACARE, the only book to explain the huge achievement of the Affordable Care Act. While the public may think health care reform is a new concern of one president, it's actually a the culmination of an effort toward health equity that began in 1792, when President John Adams signed into law the Act for Relief of Sick and Disabled Seamen.

Dawes, a health care attorney and advocate for health equity, says that like most advocates, his "Aha" moment came while working in a S.Florida emergency room. A Haitian immigrant, obviously in a good deal of pain, tried to tell the staff about her problem and was met with blank stares. She only spoke Haitian Creole, and as he saw her try to make herself understood, he thought, what if her condition is life-threatening? Every second would be critical. He saw how vulnerable patients are and how complicated health care delivery could be in the U.S.

From there in this very comprehensive text, he explains the history of advocacy for health care reform and  health equity, reform in mental health. He also discusses the role of the 2008 elections, where reform was a major issue. It was a breakthrough later, when the Tri-Caucus, the CBC and National Working Group health equity advocates were invited to the White House for a stakeholder meeting. Health disparities and health reform was being taken seriously,

Understanding the policy that developed, the fight to get it made into law, the role of legislature and the judiciary give insight into a rare instance of common purpose accomplishing what must happen. But it was touch and go throughout. Would the new law stand or be found unconstitutional? On the way to a flight, Dawes thought all the work had been for nothing, Then, in a reversal, he learned it had been reported incorrectly.

The book's mission is well summed up by David Satcher, 16th US Surgeon General, "150 Years of Obamacare provides an honest assessment of the health care law and an unparalleled explanation of
 its provisions, especially those impacting vulnerable populations. It depicts the persistence, passion and patience required to inform health policy in the United States with the goal of eliminating health disparities and promoting global health equity."

Interestingly, Dawes intends this book for those who will build on the law and improve it. History shows it's far more difficult to build a foundation for change than stymie it. Reform, like the new law, is a work in progress. The next generation can make it their own.

Though obviously no page turner, this lucid, thoughtful book is essential reading for anyone in the field. It is also useful for nonprofessionals, who want to understand the history  and possible future of our health care system. This is an instance, where the adage, "If it's not broke don't fix it," couldn't be more wrong.


  afterand the roles of legislators