Indian Country & Health Care Reform
By Mark Trahant
Seattle-based Amazon.com, the world’s largest online retailer, will move into its new headquarters near Lake Union next year. Then Amazon will leave an old Art Deco building, once known as the U.S. Marine Hospital.
What if we took this empty building and turned it into a hospital? What if we staffed it with federal employees? What kind of health care would that look like?
The answers are in our history. Congress passed a law in 1789 that provided for health care for sick and injured merchant seamen. But the thinking, even then, was broader. Philadelphia faced an extraordinary Yellow Fever outbreak in 1783 that killed more than 4,000 people (out of a population of 37,000). And therefore the primary mission of the new health service was to intercept diseases brought home by sailors returning from sea.
The Public Health Service and the marine hospital network eventually expanded across the country. This was the first “public option” because this government plan was funded by a monthly deduction from the seaman’s wages. The scope of medical activities grew as well, ranging from the treatment of epidemic diseases to industrial hygiene.
The PHS could have become the basis for a national, federal health care delivery system. By the 1970s marine hospitals and clinics served American Indians, the urban poor, as well the agency’s traditional clients of merchant marines and some federal retirees.
“These hospitals have a record of service to this nation, and especially to its merchant seamen, which is long and distinguished,” President Richard Nixon wrote in a veto message to Congress over the funding of public health. “Nevertheless, it is clear that their inpatient facilities have now outlived their usefulness to the federal government. The number of individuals they serve is declining and many of the facilities have become old and outmoded.”
Nixon articulated many of the arguments that remain a part of our current discourse on health care reform; essentially the notion that direct medical services should not be a federal responsibility. In the budgets that followed, the Nixon and Ford administrations executed an incremental implementation of that idea.
Now it’s interesting to go back and read the congressional testimony about what would happen without these government-run hospitals.
“If we close down the Public Health Service hospital system, we are also dismantling a valuable laboratory of a different sort,” said John Murphy, chairman of the House Committee on Merchant Marine and Fisheries. “As our population increases, and as the cost of medical services rises, it is clear that we must experiment with new methods and techniques for the delivery of health care.”
This was June 11, 1976. And even more prophetic, Murphy said that the Public Health Service hospitals could serve as a “yardstick” to measure both the cost and quality of health care in private institutions.
A coalition in Seattle attempted to save the hospital network. “Our PHS hospital has been in the forefront, caring for the poor and working poor who were previously left out of the medical system. Beginning with the Boeing layoffs in 1971, our hospital has served as the primary sources of assistance for 15 community clinics, established by residents of poor communities to serve their neighborhoods,” said Reynold Pilgrim, chairman of the Public Health Care Coalition in congressional testimony on June 14, 1976.
The government’s own numbers showed that the PHS system was more cost-effective than comparable private institutions. “The study demonstrates that three people can be cared for in PHS hospitals at the cost of caring for two in the private hospitals,” Pilgrim said. “The failure of the administration to realize the potential of the Public Health hospitals is a great tragedy. Our nation is in the midst of a deepening health care crisis. Medical costs are rising at twice the rate of wages, rising beyond the average family’s ability to pay.”
The health care crisis was tiny compared to today. It’s why we need to look again at those government programs that efficiently delivered health care.
President Barack Obama said just this past weekend that a public option insurance plan could work side by side with those from the private sector. “It’s the same way that public colleges and universities provide additional choice and competition to students. That doesn’t inhibit private colleges and universities from thriving out there. The same should be true on the health care front,” the president said.
I would take one more step. The Public Health Service hospitals provided additional choice and competition – at two-thirds of the cost of private facilities. We should consider going back to that future.
Mark Trahant is an advisory board member of InvestigateWest and the former editor of the editorial page for the Seattle Post-Intelligencer. He was recently named a Kaiser Media Fellow and will spend the next year examining the Indian Health Service and its relevance to the national health reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. www.marktrahant.com
It should be noted that the Public Health Service was also responsible for the Tuskegee Syphillis study. Perhaps government health care isn’t always so good.