Reflecting on health equity and the ‘Great’ Society
By Dennis Archambault
At this precarious moment in health policy, when the call to make America “great” comes with the goal of dismantling the Patient Protection and Affordable Care Act (ACA), it’s good to reflect on the often cited quote by Dr. Martin Luther King, Jr.: “Of all the forms of inequality, injustice in health care is the most shocking and inhuman.” Dr. King spoke those words in the context of a speech he gave to the Medical Committee for Human Rights in Chicago, 1966. At the time, the Great Society was rising, and there was great hope the civil rights would extend into the realm of access to quality health care for all, and ultimately, health for vulnerable populations.
“Great” in that society was meant to be inclusive. An affluent society could afford to properly care for its elderly, disabled, and low income populations through health and human services. Even those of a more conservative bent adopted a “compassionate” perspective that the needs of the poor should be addressed in some baseline way. That led to thinking about a two-tiered approach to care.
Today, Gov. Rick Snyder and others who realize the social and economic value of expanded Medicaid – for those who fall within 133 percent of the federal poverty level – are calling on president-elect Donald Trump and his administration to preserve this important component of the ACA, which has ensured that more than 600,000 Michigan residents have access to the same quality of health care as everyone else – a major step toward resolving the inequality and injustice that Dr. King spoke about in 1966. As the president and Congress review the ACA, Gov. Snyder says, “I hope they carefully look at the success we’ve had in Michigan, because we didn’t just do Medicaid expansion. We put requirements for health and wellness on the front ends, and personal responsibility.” While that latter requirement is controversial, most community health people would agree that incentives are helpful in getting people to adopt good health behaviors.
Health analysts are noting that expanded Medicaid is likely to go with several other provisions. It’s uncertain what would replace the ACA. There’s talk of block grants to states. There may be a yet-to-be disclosed plan that Congress will reveal. Proponents of universal coverage have felt that the ACA wasn’t the right solution. Opponents of a national health policy of any kind have opposed it. It’s hard not to conclude that it’s a return to the attitudes that prompted Dr. King to conclude that inequality and injustice in health care is the most shocking and inhuman of all forms of inequality. Dr. Brian Smedley, co-founder and executive director of the National Collaborative for Health Equity noted shortly after the 2016 presidential election, put it into perspective “The expressions of bigotry, racism, misogyny, and xenophobia in the aftermath of last week’s election must be stopped. But the ideology behind these attacks – even if never expressed – also poses a tremendous barrier to building a Culture of Health, which priorities equity and values all populations equally.”
It is a precarious moment for health policy. And as health policy has reflected society in so many ways, it’s a precarious moment for society. As the debate to preserve access to health care – and access to health – we would be wise to reflect on Dr. King’s quote. But also consider another often-quoted reference from the civil rights leader: “A genuine leader is not a searcher for consensus, but a molder of consensus.”
The debate that has waxed and waned in American society since Dr. King’s era has been revived, as has the meaning of what makes American society “great.”
Dennis Archambault is vice president, Public Affairs, for Authority Health.