In the summer of 1972, two days after the Watergate break-in, Simon & Schuster published Sen. Edward Kennedy’s second book, a scathing condemnation of American medicine entitled In Critical Condition: The Crisis in America’s Health Care. Composed largely of excerpts from recent testimony before Kennedy’s Senate subcommittee on health, it was clearly intended to introduce his proposed Health Security Act, which would replace private health insurance with a government-run system (“Medicare for all”) and, in due course, closely regulate clinics, hospitals, the pharmaceutical industry, and the practice of medicine itself—an American version of Britain’s National Health Service.
Nearly a half-century later, In Critical Condition is of interest largely as an artifact of its times. Even in the ongoing, seven-year debate about Obamacare, few Democrats now would advocate anything remotely resembling Kennedy’s 1972 vision of socialized medicine—including Kennedy himself, who conceded in 2009 that he had long since “come to believe that we’d have to give up on the ideal of a government-run, single-payer system if we wanted to get universal care.” Much had changed in the intervening decades, not least a steep erosion of public trust in the capacity of the federal government to deliver anything as important as health care.
But the operative word in Kennedy’s title is “crisis,” and therein lies a tale. For while In Critical Condition is a wholesale Aquarian Age indictment of American health care—in one chapter he declares that “we can no longer afford the health insurance industry in America,” in another he threatens that “many physicians will have to give up their solo or single-specialty-group practices”—today’s debate is almost exclusively about insurance coverage. In Edward Kennedy’s America, doctors are grasping businessmen who pursue clinical specialties in order to “fragment” health care, and hospitals are Dickensian flophouses where patients are simultaneously ignored and overcharged. Nowadays, few people would take Kennedy’s diagnosis seriously, but the “crisis” label has stuck. Indeed, it remains a political truism, almost beyond discussion, that American health care is in crisis, has been in crisis since time out of mind, and is getting steadily worse.
That, certainly, was the urgent message a quarter-century ago when Bill Clinton commissioned his wife Hillary and Clinton comrade-in-arms Ira Magaziner to produce their own version of a Health Security Act: “Millions of Americans are just a pink slip away from losing their health insurance,” President Clinton warned Congress in 1993, “and one serious illness away from losing all their savings. . . . Our medical bills are growing at over twice the rate of inflation.” When the first lady subsequently testified before several congressional committees, the word “crisis” was routinely, and pointedly, invoked.
It may be useful, at this juncture, to recall that when the Clinton legislation finally collapsed in Congress—having never been brought to a vote—both the Senate and House were in safe Democratic hands. It is certainly true that congressional Republicans had largely opposed the Clinton initiative, just as they would later resist the Affordable Care Act; and there was a smart, well-organized public campaign against Hillarycare, now largely remembered for the Harry-and-Louise TV commercials underwritten by the health-insurance industry. But among the multiple reasons why Hillarycare failed, the most likely explanation is that Americans believe that while there is plenty of room for reform in the realm of insurance coverage, the American system of health care is not in crisis. And as systems of health care go, in a polyglot nation of 325 million, it is a remarkably good one.
In Critical Condition ends, inevitably, with rapturous descriptions of nationalized systems in tiny, homogenous Scandinavian societies (Sweden, Denmark) and Britain’s NHS. But while Western European health care may be “free,” in the sense that payment is not required on delivery, it tends to be the sort of health care one would expect for free—and practitioners have little financial incentive. Americans have unusually high levels of expectation in health care and would be unpleasantly surprised not only by the quality of medicine in socialized systems—systems now strained to the breaking point by costs and population—but by limitations on care as well: waiting lists for major surgical procedures, maximum ages for lifesaving therapies, the chronic shortages and inefficiencies of unionized, government-run programs.
By contrast, the American system is a crazy-quilt, hybrid, evolutionary pattern of private and public care, of public and private standards in education and training, of infinite varieties of finance and delivery—and levels of care far beyond the expectations of sick people in Sweden. You can be hospitalized in a public institution in a rural county in the poorest state in the union and reasonably expect the latest technology and superior care. Moreover, In Critical Condition notwithstanding, America’s uninsured do not go untreated because they cannot pay: They are treated, by law—and their treatment is subsidized by those who can pay.
Congress would do well to bear in mind that ours is a health care system, like any gigantic and complex enterprise, in need of adjustment, of adaptation to needs and capacities— of reform, if you will. It was not in 1972, and is not now, a system in crisis.
Philip Terzian is literary editor of The Weekly Standard.
