Last night was just about the best night's sleep I've had since I started my career in healthcare nearly thirty years ago. I started working in the early eighties in Wichita, and I entered the field just as the first bricks of the crumbling system were begining to fall down around our ears. We shored it up and soldiered on, but I have known from day one that it was FUBAR -- literally, my first day working in the ER at Wesley Medical Center, a car from Oklahoma pulled up to the doors and pushed out a 59-year-old uninsured man who had suffered a stroke out of the back seat of the car in the ambulance bay and sped away. I was horrified and didn't hide it, but a nurse with fifteen years under her belt snorted and said "Happens all the time, Sweetness."
That was my first clue that things were well and truly fucked, and that my moral belief that healthcare was and is a basic human right was not a position everyone shared. Her words would echo in my head for years, because in the years I worked, that same thing happened literally hundreds of times, and it happened in every Emergency Department I ever worked in.
I have watched as premiums climbed and care was compromised. I have served my community through the malpractice crisis that saw women in labor being flown by helicopter from western Kansas to one of the hospitals in Wichita because there wasn't a doctor within 150 miles of their town that would deliver their baby.
I lived through "capitation" by HMOs in the nineties. Capitation punished doctors financially for providing appropriate care for their patients, and people died as a result.
I lived through worrying about my own children as they, one after another, aged out of the system that covers us. At some point, all three of them lived without insurance for a while when they were young adults because they were kicked off ours, couldn't afford to buy their own and working jobs that didn't offer it.
If it had been up to me, Clinton would have gotten it done and we would be at single payer by now, but that didn't happen, and playing the what-if game is a waste of time because it didn't happen. But that wasn't the case this time around, and we really did get something done.
It isn't the single-payer, universal system that we need, but it's a start, and frankly, if we got that overnight, it would be a mess. Before we can serve the needs of everyone in a universal coverage system, we need to train, at minimum, 100,000 new primary care physicians and 250,000 Nurse Practitioners and Physician Assistants.
That is the reality of our system that continued to crumble for thirty fucking years before we did anything about it.
This is not the sort of mess that is going to be cleaned up easily or overnight. There is no magic bullet, no special incantation that can be chanted, no wand that can be waved.
Yesterday's ruling that upheld the law is just the beginning. Now that we have it, we have to fight like hell to protect it, and expand it to cover more people. But we also have to fight like hell for the infrastructure and the providers that we need in order to get to that civilized ideal: true universal coverage for all.