Hamilton and the American Healthcare Revolution
“Am I then more of an American than those who drew their first breath on American ground?”
- Alexander Hamilton, 1795
Each year on July 4th the United States celebrates independence for our ancestors who did not draw their first breath on American ground. Eighty-nine years after the declaration of independence was signed, a day of delayed emancipation was celebrated on June 19th (Juneteenth), 1865 for those with ancestors who drew their first breath on the African continent.
On July 4th I celebrated the day by watching the much anticipated television streaming of Hamilton. The Broadway hit, based on Ron Chernow’s biography of Alexander Hamilton, is a musical adaptation of the life of a Caribbean immigrant who survived all odds to become an unsung hero of the American revolution. His legacy remained unsung for 210 years after his untimely death in a dual with Aaron Burr. With the exception of his portrait on the ten dollar bill, Hamilton’s story was lost in the shadowed attic of our nation’s history.
In 2008 when Lin-Manuel Miranda conceived, what his friends thought it was a drunken joke, the idea of composing a hip-hop album about the life of Alexander Hamilton. In 2009 his ensemble received a standing ovation from those assembled in the East Room of the White House after performing excerpts from the developing play that would debut on Broadway in 2015.
Among the many brilliantly crafted songs were four that ignited my desire to write this article.
In their order of appearance in the show: “My Shot,” “History Has Its Eyes On You,” “The Room Where It Happens,” and “Who Lives, Who Dies, Who Tells Your Story?”
On the evening of November 2, 2015, President Obama walked onto the stage of the Richard Rogers Theater in New York to give his remarks, after having seen the completed production of Hamilton. Among those remarks were the following, “One measure of America’s health is how warmly it embraces the diverse souls who live here.”
The play he had witnessed was a story of an American revolution as told by a racially diverse cast of characters. As I watched this particular portion of the play, the lyrics ”I’m just like my country. I’m young, scrappy, and hungry. And, I’m not throwing away my shot…” reverberated in my consciousness. My thoughts were met with the present day reality of the over 26 million protesters (the largest protest in U.S. history) that had risen up to express their collective frustration that the unalienable rights of all Americans had not yet been achieved after 244 years of waiting. Too many of our citizens are still awaiting their shot to be warmly embraced by unfettered opportunities.
Hundreds of other government and private sector organizations issued a statement declaring all forms of implicit institutional and systemic racism to be against their values and not to be tolerated. The fact of the matter is that not only have they been tolerated for far too long, they have had a great toxic effect on our national body. Thus, it is my belief that we may be on the cusp of seeing these issues for what they truly are: A Public Health Crisis.
I am far from the first person to say this, but as the President of the American Association of Family Physicians, I want my membership and those they serve to understand that systemic racism is not a preplanned social conspiracy. Mine is not meant to be a political statement, nor is it an attempt to cast blame on any one group for the inequities the U.S. Department of Health and Human Services continues to objectively confirm each decade in their “Healthy People” publications. We are all to blame if we fail to assist in exorcising the implicit societal biases insidiously hardwired into our socioeconomic and industrial systems. We must deny implicit bias the fuel to feed the fire of diminished opportunities for any human being. Silence is no longer an option. The AAFP will not throw away its shot of advocating for the American we so faithfully serve.
History Has Its Eyes On You
In 2019 the AAFP celebrated its 40th year as a specialty of medicine. We entered this new decade with the bold intention of leading our nation forward toward improved healthcare outcomes for all Americans by using the intellectual principles of primary care as the stable foundation to build national health care reforms.
Historical decisions, that impact our member’s ability to provide medical services to all populations, were made this summer when the U.S. Supreme Court ruled to preserve the Deferred Action for Childhood Arrivals (DACA) (visit https://www.aafp.org/media-center/releases-statements/all/2020/aafp-welcomes-supreme-court-decision-preserving-daca.html); and upheld the right of trained physicians to provide legal medical services without unnecessary interference (visit https://www.aafp.org/media-center/releases-statements/all/2020/supreme-court-decision-prohibits-interference-in-providing-legal-medical-services.html). The AAFP welcomed both rulings.
We also supported preserving and strengthening protections provided to patients by the Affordable Care Act (vist https://www.aafp.org/media-center/releases-statements/all/2020/aafp-supports-legislation-to-build-on-successes-of-affordable-care-act.html).
We have a proud history of striving to fulfill our vision statement to: “Transform health care to achieve optimal health for everyone.”
The Room Where It Happens
Family physicians provide our nation with ~190 million office visits each year. We are truly in the rooms where essential health care is being delivered.
Not unlike the cast members of Hamilton, who can sing, dance, act and rap, our members are multitalented medical specialists. During the COVID-19 pandemic many of our members have been enlisted to expand their professional services to cover hospital emergency rooms, intensive care units, nurseries, extended care facilities, etc. These services are being provided by family physicians in addition to - or at the exclusion of - their ambulatory care practice duties.
The AAFP has not paused during this era of social distancing. To the contrary, we have made a conscious effort to use innovative technologies to virtually move closer to our members by providing them with a series of educational COVID-19 town halls, website updates, and rapid response member network communications.
Who Lives, Who Dies, Who Tells Your Story
In the final analysis it is our story to tell regarding the value the specialty of family medicine has contributed to our nation, and our respective communities - prior to and during the COVID-19 pandemic. This is our once in a generation opportunity to not just tell our story, I am asking right now for you to use whatever tools and resources you have to tell our shared story. The triumphs of health and wellness that made you and your family better. Tell the stories of the receptionist who’s smile and patience made the wait or the process a bit easier. Tell the tale of the health worker who put aside the those few testy people they have to deal with and gave you their best self. Talk the talk of the doctors and nurses who come to serve while at the same time putting themselves and their own loved ones at higher risk because that is what they do.
Share the stories of those people you know on the frontlines of this century defining moment for the sake of drawing us all into our shared goal of human health and escalated dignity.
By working together, we will tell generations to come about how we took a world turned upside down by a pandemic and turned it right side up again to support the healthcare needs of an entire population of people. The year 2020 is not over, but the historical events we have witnessed thus far have left us breathless with anticipation of the stories yet to be written about those who lived, who died, and those who will tell the story of this new American healthcare revolution.