Monday, September 14, 2009

Look Back to See the Future

In a recent 60 Minutes news forecast (American TV News Magazine, there was an interview with President Obama. The major focus of the interview was the battle to initiate health insurance into the American system.

In a revealing article in the Fall 2009 issue of Yes! Magazine, author Brooke Jarvis reveals all the mistakes Barak Obama is making, despite his background as a community developer and his successes in poor communities with an example from the past. She tells the story of academics and analysts who came together over the issue of health care as they saw workers, elderly and poor people who were in desperate need. However, they din't go to the people who need the care and help them to organize, they made their appeal to those they saw as having the direct power to make the necessary changes. Those in power were, in this particular case, the medical profession, the insurance industry and conservative politicians who got defensive and killed the initiative.

This sounds very much like what happened in the last struggle for a comprehensive health coverage intended to bring services to the masses of un- and under-served under President Clinton. Ms. Jarvis surprises us by saying that this particular incident describes a health care initiative from 1915!

She points out the same pattern in the 1920's, as a part of the New Deal, "the Wagner-Murray-Dingall bill of the Truman era." They ignored grass roots movements and succeeded in sucking the fight out of what those movements felt was their initiative.

Jarvis quotes historian Beatrix Hoffman, who states the real problem to be faced is that the proposals came from elites who sought to compromise with interest groups, where they believed real power lay, rather than to ally with grassroots movements and their supporters among everyday Americans. Those trying to make the reforms gave in to the powerful stakeholders, ignoring the strength of people in need. Even existing social movements for "civil and women's rights, organized labor", and those from the grassroots fighting for attention for specific diseases like AIDS, cancer, heart disease, obesity and diabetes could have contributed to the fight.

This article highlights the need for looking back and finding patterns. Isn't that what good psychiatry is about- helping people to understand that there is a pattern to all the mistakes they make and then encouraging them do something different? Why is that different when talking about large populations of individuals? The message for President Obama is clear. Go back and encourage those who propose a single-payer solutions encourage them to be heard, to demonstrate and fight for what they want. Look back and you will see the future!