Guest Commentary: History in the Making - A UK Physician Witnesses US Health Care Reform

Louisa Baxter, MD, MSc, MRCP
Harkness Fellow
Jefferson School of Population Health


I was glad that I had bought some beef jerky the night that the health care bill (forgettably titled the Patient Protection and Affordable Care Act) was passed. Using my English accent and prepared to stand in line for 12 hours, I found myself hungry at 11pm in Congress as the final votes were counted.

It had been a day of marvelous extremes; I had met Catholic nuns for the bill and family practitioners against it. At one stage, it appeared that I had found myself in the Sarah Palin inner circle, where earnest ladies from Alabama explained their admiration for her forthrightness and clarity of speech. Old veterans draped in the American flag offered me coffee from a communal flask emblazoned with GO OBAMA GO!

To an outsider (although one who now names Philly as her second home) the success of the health care reform bill seemed as momentous as the passing of Medicare many years earlier. For a doctor who practices in the UK – the home of “socialized medicine” –expanding coverage and providing subsidies for this, alongside further investment in “meaningful” IT use and propping up the nation’s beleaguered primary care doctors, these changes resonate deeply with our values in the National Health Service.

However it is clear that the newborn bill remains under fierce attack and implementation, devolved to the state level, will be a tangle of muddling through. Unlike Medicare which was a war of interest groups, this new bill has been the casualty of vicious party political wrestling. The polemics have been startling to a foreigner and the drama almost intoxicating. The patient’s voice often seems lost in the process or cruelly manipulated by both sides to meet their agenda.

What struck me, however, at 11pm on the 22nd March as I sat on plush maroon velvet seats, shoulder to shoulder with a farmer from Idaho, was the strength of feeling in the American people, many of whom had stood in line with me all day, with their children and their packed lunches and their US flags. Although we may despair at the political wrangling and deal making that characterizes the passage of any bill, it is powerful that a nation can mobilize its citizenry to come out in support of their values and possess the constitutional safeguards that allow a free and fair discussion of these.