Opinion: To improve health care, we must ‘begin with a war against bad government’

I hear every so often that we should keep politics out of health care. That may be true for partisan politics, but I believe that political oversight of health care policy, when done right, can be beneficial.

From its birth out of Western philosophy, modern medicine has always been closely intertwined with politics. Take, for example, the hospital, the heart of our health care system. When French philosopher Michel Foucault explored how the modern hospital came to be in his landmark book, “The Birth of the Clinic,” he found that it emerged from the political turmoil of the French Revolution.

By the end of the 18th century, the revolution had swept throughout France, carrying with it new waves of political thought. One of these started as a myth: that the medical profession could be nationalized and revenue evenly distributed so doctors would not have to demand fees for their services. In such a system, doctors could focus more on the care they provide than the money they receive. Treatment of the sick would become, in Foucault’s words, “free and obligatory.” This myth fed into another: that with this more effective delivery of medical care, diseases themselves would be eradicated, making the doctor’s role as a caregiver only temporary.

To provide this service, doctors would have to change the way they practiced medicine. They would have to consolidate, form groups, and work together in the same environment. But with this consolidation came new oversight. Foucault found that in this hospital system doctors had to “give an account to [their] superiors” and “would be held responsible for [their] mistakes.”

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The birth of the hospital, then, coincided with the birth of new regulations that dictated how doctors practiced. As with any type of regulation, there is a delicate balance between too much and too little, and this balance often depends on the political climate of the time.

The once-healthy connection between health care and politics has, at least in the United States, devolved into a state of perpetual uncertainty. The passage of the Affordable Care Act under the Obama administration, though it had lofty aims — offering millions health care coverage who could otherwise not afford it while also barring insurance companies from excluding individuals with preexisting conditions — was an exercise in partisan politics, with all 60 Democrat and Independent senators voting in favor of it and all 40 Republicans either voting against it or not voting.

The Republican Party has tried on numerous occasions to repeal the ACA. The Trump administration’s recent efforts to replace the ACA have been as political and as partisan as was the effort to create it. During the latest attempt, the Graham-Cassidy bill went down to defeat only because Republican Senators Susan Collins, John McCain, and Rand Paul said publicly they would vote “no,” denying their own party the chance to revoke the coverage of millions.

The Republican efforts to repeal and replace the ACA with various plans seems akin to throwing darts at a blank wall. And although they have not been successful, they have sowed enough uncertainty among insurance companies that some have opted out of ACA markets and raised premiums, while instilling fear among the American public that they may lose their coverage tomorrow.

How can we make our health care system work? Foucault argues that a doctor’s first task, before seeing patients, rendering a diagnosis, and offering treatment, is a political one. Specifically, he suggests that doctors must first “begin with a war against bad government.”

In the context of our current political climate, this exhortation should extend beyond doctors to every citizen of the country. Their fight for coverage and for their right to receive care is just as important as doctors’ obligations to provide it. Putting partisan politics aside, we need to fight for a fair assessment of our health care system and work to improve it rather than opting for a repeal that would leave millions without coverage.

Brian R. Carr is a third-year student at the University of Pennsylvania School of Dental Medicine.