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Obamacare: A scholar’s tale

With mortality rates from infectious diseases rapidly declining, more chronic illnesses like diabetes, cancer, and cardiovascular disease had emerged as the leading causes of adult deaths. Without cures, what should clinicians do? The answer: prevent them from occurring in the first place.

The chant to "repeal and replace" Obamacare threatens six years of my scholarly life. My newest book, Nursing with a Message: Public Health Demonstrations Projects in New York City, begins and ends with Obamacare, otherwise known as the Patient Protection and Affordable Care Act or, more simply, the ACA. In between I write about innovative nurse managed health clinics in New York City in the 1920s and 1930s. These clinics were established as "demonstrations" that sought to bring high quality, cost-effective, and carefully coordinated health care to individuals and families too poor to access private medical services. They faced the central dilemma of the post-World War I era. With mortality rates from infectious diseases rapidly declining, more chronic illnesses like diabetes, cancer, and cardiovascular disease had emerged as the leading causes of adult deaths. Without cures, what should clinicians do?

The answer: prevent them from occurring in the first place.

So my public health nurses took up the challenge of health promotion and prevention. These nurses visited schools, churches, and homes to encourage neighborhood residents to engage in healthier lifestyles through diet and exercise, to value preventive physical examinations even when not ill, to make dental care routine, and to establish vision and hearing assessments, part of a battery of tests that would identify "defects" before they became problematic. It was important for adults to engage in these kinds of activities rather than illness care. It was even more important, they argued, for their little children who were seen as particularly vulnerable.

And it is as simple that we need continued support for the maintenance and expansion of the healthcare delivered in community health centers, care delivered by nurse practitioners as well as physicians and physicians' assistants. I am glad that there seems to be discussions about keeping coverage for pre-existing conditions and young adults on their parents' health plans in the "repeal and replace" debates about Obamacare. But for those poor, vulnerable, and dispossessed individuals, families, and children served by FQHCs it is life – or suffering, or death. We must fight to see their survival and their expansion, not because it is the data-driven or financially sound thing to do, but it is now the moral thing to do.

Patricia D'Antonio, PhD, RN, is Killebrew-Censits Term Professor in Undergraduate Education Chair, Department of Family and Community Health, and director of the Barbara Bates Center for the Study of the History of Nursing at the University of Pennsylvania.

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