What Lincoln, Johnson and Biden May Have in Common — The Burden of Too Many Gravesites
We Must Heal a Nation Divided — Politically and Medically
By the time the guns fell silent on the fields of Gettysburg on July 3, 1863, more than 40,000 soldiers — wearing grey and blue — lay dead, dying or wounded. Later that year, our nation’s 16th president, Abraham Lincoln, read words penciled on the way to the Gettysburg gravesites: the American government is “…of the people, by the people, for the people…”
Today, we imagine the graves of 400,000 Americans — identifying red and blue — who perished from COVID-19. Too many have died due to a nation divided, the absence of consistent state policies requiring mask use, or from the failure to mobilize a vaccination roll-out that people at the highest risk could easily access and navigate.
Newly inaugurated President Joe Biden now takes up the role in which Lincoln once served. He has his work cut out for him, but history can be his guide. He must heal a nation divided — politically and medically.
A Nation Divided or United Around Health
In 1964, a century after Gettysburg, two groups of Americans were largely uninsured: the elderly and the poor. But Medicare and Medicaid bills — debated, passed and perfected over time, first by way of a Democratic congressional majority and then improved through bipartisan action — lifted people up from fear of suffering and poverty. They were cornerstones of President Lyndon B. Johnson’s Great Society achievement.
Some 56 years later, these public health safety nets remain foundational to the American health system. While we are facing new, unprecedented challenges, we can look back to the aspirations of a nation torn apart in 1864 and the bitter policy battles in 1964 as models for coming together for the sake of the people.
For nearly a year now, the COVID-19 pandemic has been the mainstage global concern, bringing health systems and economies to the brink of destruction, and decades of pressing public health challenges into the light. These underlying crises — systemic racial injustice that leads to health disparities, mental-health stigma, hurdles to preventive care and a preference for sick care — are equally urgent, yet cannot be inoculated against.
COVID-19 enables us to see injustice through the harsh reality of some 30 million unemployed Americans. “The State of Health Insurance in COVID-19 America,” a recent survey conducted by Civis Analytics together with Finn Partners, paints a stark picture of the future health of this nation. Millions of people who lost jobs due to the pandemic also lost their health insurance, a trend disproportionately impacting Black Americans. Can we afford the inevitable result of employment-generated health insurance in which millions lose not only their jobs but their medical benefits?
Reflecting on the great social changes that were occurring in 1964, we can see a parallel. Lawmakers of both parties acknowledged that improving the imperfect drives the nation forward.
Today, while President Biden inherits a nation divided, perhaps this virus can unite us in a common cause. The new administration and an evenly split Senate must not turn their back on consequences brought on by a fractured health ecosystem. In 1964, President Johnson fought tooth and nail to enable his bill to become law, but afterward, Congress saw the benefit in addressing senior-health needs and moved to perfect the imperfect — not dismantle it. Today, nearly all seniors have access to health care through Medicare, an American success story and one of the great Federal benefit programs guarded by political leaders from both sides of the aisle. Like Social Security, Medicare survives owing to citizens’ demand that lawmakers guard what they view as an essential benefit — embodying government by the people, for the people.
Helping the Vulnerable Must Continue
Among the biggest defeats of the Trump presidency — and among the greatest victories for the American people — is the survival of the Affordable Care Act (ACA), best known as Obamacare. The law opens the door to quality healthcare and protection against catastrophic illness or injury for people who do not have health insurance, including the millions who lost coverage due to pandemic-related job losses. Also, importantly, it ensures that individuals with pre-existing medical conditions can continue to access life-sustaining care — and that pregnancy is not considered a “pre-existing medical condition.”
With the health and economic wellbeing of millions in the balance, we will see the mettle of our elected officials when it comes to their commitment to preserving lives. Ideally, rather than dismantling a law that is sustaining people’s health, we can make access to medical care a bipartisan achievement. Disease and death await us all, sooner or later — hopefully, the latter. Looking to our own futures, we will all want and deserve access to life-extending treatment and comforting, life-concluding medical care. Understanding that the people share this desire — and deserve the same — should be the starting point for discussion.
We Must Recognize the Cost of Not Engaging
Empathy for others is indeed a key component of progress. Yet empathy aside, policy should align with good economic sense. Even if we can’t see each other’s pain, we must recognize the cost of not engaging. At some point, taxpayers will pay the bills for others’ illnesses.
With a multi-billion-dollar burden of uncompensated care shared among governments and private sponsors, ultimately, taxpayers shoulder the cost of medical services provided to the impoverished. Pay now or pay later: that’s the choice our elected officials and we must come to grips with as we work toward perfecting the imperfect ACA.
Today’s lawmakers must remember this point, so painfully illustrated during the past several years, but especially during the last several months: those with health benefits have a chance at beating the injustice of disease. What is needed is the political will to make care accessible.
Now, with a new administration and Congress, it is time to fulfill the words of our Declaration of Independence. Life, liberty, and the pursuit of happiness are the unalienable rights our nation’s founders declared given to all humans by their creator and — crucially — which governments are created to protect.
We are a nation of the people, by the people, for the people — represented by a government reflecting the same. It is time to build upon Medicare, Medicaid, and the Affordable Care Act and continue to perfect the imperfect. Obsessing over ACA imperfections is a distraction we can no longer afford: it is time to build up, not tear down, in order to improve the health of our people and our nation. Let us rise up to the historic opportunity before us, and ensure our citizens do not face the dual injustice of unwarranted disease and destitution.
[Many thanks to Finn Partners colleagues Arielle Bernstein Pinsof and John Bianchi for their comments on this article.]