In 1776, Thomas Paine published his wildly popular pamphlet, Common Sense, calling for American independence from a British government that had lost touch with the best interests of colonial society. We all know how that story ended. In Paine's spirit, I more modestly propose that we join together to make a stink -- a Great Stink -- to force our current leaders to jumpstart health care reform: Give senators and representatives 6 months to enact health care reform -- or else automatically lose their own federal government health insurance. If they don't deliver, they'd have to fend for themselves like the rest of us in today's health care jungle.
Before dismissing this proposal as lacking in Common Sense, consider the case of the sudden legislative birth of England's historic sanitary reform -- after years of dithering -- in little more than 2 weeks in the summer 1858. The catalytic midwife in that instance was a putrid stench, known to history as the Great Stink, that arose from the filth in the river Thames, forcing elected legislators to personally experience the daily condition of their constituents.
The Great Stink burst into existence during a prolonged heat wave in June 1858. Despite the MPs best efforts to seclude themselves behind heavy lime chloride-soaked window draperies, it penetrated the Houses of Parliament adjacent the river. What agitated legislators most was not the nuisance of the bad smell itself, but a primal fear for their personal well-being, based upon the prevailing medical theory of the day that deadly diseases, including the dreaded cholera, were transmitted by such foul air.
The Thames at the time was a porridge of untreated sewage and human waste discharged from London's cesspools and rudimentary sewers. The contaminated river water was being pumped up and consumed by London's thirsty, fast-growing working class population of the early industrial era. Since water is by far the main transmitter of human illness and premature mortality, the toll was terrible in districts that lacked the means for wholesome, alternative sources. Most horrific were the recurring pandemics from water-borne cholera bacteria that spread from continent to continent and brought agonizing death from acute dehydration to tens of thousands. England had first been struck in the early 1830s. In the decade before the Great Stink, over 25,000 Londoners had died in two cholera outbreaks.
Legislators' political will for sanitary reform had oscillated with the episodes of cholera. Even before the germ theory of disease, they knew generally what to do to improve public health, just as the ancient Romans had--discharge sewage far downriver from drinking water intake valves and purify or pipe in clean water from other sources. Yet as long as the MPs felt personally insulated from the risks of the unsanitary conditions, they were unable to muster enough momentum to overcome the familiar nexus of entrenched special interests, budgetary cost objections, and ideological opposition to any centralization and enlarged public role for London's municipal government.
When the 1858 heat wave and stench abated one day, the Times of London bemoaned that it was "a pity" because it relieved Parliamentarians of the pressure for reform. Fortunately, the Great Stink quickly returned to strike mobilizing fear into the hearts of legislators. In mid-July, Benjamin Disraeli rose to introduce the long overdue, far-reaching sanitary reform. The great issue that had been debated fruitlessly for years was enacted in just 18 days. It proved to be an historical watershed event that helped galvanize a virtuous circle of sanitary and public health reforms among industrial democracies, transformed the physical quality of human life, and facilitated the rise of modern urban society.
The reforms inspired by the Great Stink are also a reminder of Thomas Paine's common sense lesson -- that it is healthy in a democracy for legislators to personally know the conditions of those they represent. To help invigorate that personal bond, my modest proposal calls for immediate, self-imposed legislation (preferably bipartisan, of course!) that gives our lawmakers in Congress until September 30 to enact meaningful health reform before automatically cutting off their own federal health insurance. Placing the deadline before the November elections will help expose any shenanigans before voters enter the ballot booth.
Facing a deadline directly affecting their personal lives hopefully will encourage legislators to focus pragmatically on breaking the health care stalemate, as it did their British counterparts on sanitary reform 150 years ago. If not, a 'tough love' experience in the real world of health insurance will sober everyone for future reform efforts -- while making a constructive, if minor contribution to budget deficit reduction in the meantime.
Like many Americans, I'm personally agnostic whether health care reform should be public or private, with mandates or without, or exactly how many uninsured it should cover. What matters most is that it meaningfully starts to make coherent, common sense of a system obviously gone awry, even for the fully insured like myself -- and that in a larger sense it provides us with some hope that our democratic governing process is not utterly incapable of tackling the even greater reform challenges we all know loom ahead.
If Thomas Paine were alive today, he'd certainly be making a Great Stink about it.
How Vote Ye: Yea or Nay?!
Steven Solomon is author of the WATER: The Epic Struggle for Wealth, Power, and Civilization (HarperCollins 2010).
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