The Time is Right to Revisit Health Care for All – A Review of Dr. Quentin Young’s Everybody In, Nobody Out: Memoirs of a Rebel Without a Pause

“The time is always right to do the right thing.”

― Dr. Martin Luther King, Jr

The US response to the public health crisis of the pandemic and extremism has been sorely lacking. While these two infections may seem unrelated at first, there are ways that they are interconnected.

Institutional policies of inequality lead to poorer medical and social outcomes (see Wilkinson & Pickett’s The Spirit Level: Why Greater Equality Makes Societies Stronger). Inequality is also leading to higher death rates from “diseases of despair” from overdoses, suicides, and the consequences of alcoholism (see Deaths of Despair and the Future of Capitalism by Case & Deaton). In areas with higher rates of deaths of despair, there have also been “votes of despair” for nationalist, racist, authoritarian leaders.

Health is health. All health is holistically interconnected – physical, economic, social, political, moral, and spiritual.

Today, on Martin Luther King Day, I would like to give a brief review of the work of Dr. Quentin Young (9/5/1923 – 3/7/2016). I was familiar with Dr. Young’s work when I was a medical student and resident in Chicago (1989-1997) as described in Everybody In, Nobody Out: Memoirs of a Rebel without a Pause (2013). I saw him speak on Physicians for a National Health Plan and I would hear him occasionally on WBEZ Chicago Public Radio. He was a champion of Cook County Hospital and reading his book takes me back to my time in Chicago and my fond memories of clerkships at the old Cook County Hospital, Fantus Clinic, and Jorge Prieto Clinic where I did my family practice, general surgery, surgical oncology, and plastic & reconstructive surgery rotations as a medical student.

Over the past five years, I have felt a growing responsibility as a physician and a professional to speak up on what I have seen as public health risks from the attitudes, statements, policies (and lack thereof) of this presidential administration that is now in its last few hours. I have written on the need for physicians and professionals to have an identity that includes public, social, and moral responsibilities that go beyond the doors of the consulting room. (See Medical Activism: A Foundational Element of Professional Identity).

Dr. Quentin Young embodied the archetype of the physician as medical activist. He was Dr. Martin Luther King’s doctor when King was in Chicago – writing that he “became my hero…and my patient,” (53). He marched alongside Dr. King and tended his scalp laceration after being hit with a rock – after which Dr. King said, “I have to do this―to expose myself―to bring this hate out in the open,” (65). Dr. Young championed Cook County Hospital and sought to strengthen its network of community clinics when he was Chairman of Medicine there 1972-1981. Here is what he said he learned at County, “I am convinced that until we, as a nation, have a system of universal health care, including everyone―everybody in, nobody out―until we provide that, we as a society must provide care through a system like County,” (36).

Dr. Young was an active member of many different civil and human rights movements, including the Medical Committee for Human Rights where he marched and provided medical care in the South, he marched in Chicago with Dr. King, he provided medical care on the street at the 1968 Democratic National Convention, he was the founder of the Health and Medicine Policy Research Group, he served as president of the American Public Health Association, and national coordinator for Physicians for a National Health Program – to name just a few organizations. Throughout his career he worked for racial justice, universal health care, and improving the health care of the poor and marginalized. His work was as a doctor, an activist, an organizer, and a change-maker – in short, a medical activist par excellence. Dr. Young was not afraid of a good fight and his work brought him before the House Un-American Activities Committee before it disbanded in the late ‘60s.

Medical Witness

I had heard of the term, bearing witness, from my background in trauma work. Dr. Young writes that the term, medical witness, was used in the Civil Rights movement. The work of the doctor in the Civil Rights movement was, “we bore not only our doctor’s bags, but witness,” (57).

“‘Medical witness’ was a term used in the movement to refer to bringing focus to an issue of indignity or an issue of inequity: visiting doctors offices that had ‘colored’ and ‘white’ waiting rooms, hospitals that had segregated wings and the very obvious disparities between the African American population and the white populations,” (74).

The Good Fight in the Name of a Good Cause

Dr. Young summarized a few teaching points on the good fight (pages 171-172).

  • Don’t be afraid to say the same thing over and over again to lots of different audiences
  • Always use sarcasm and humor
  • Draw on every literary and artistic device you can from Shakespeare to the Smothers Brothers
  • Always connect lots of different struggles: from struggles against racism to struggles to end the war to struggles to get resources for the community
  • Always remember to draw on and recall past great heroes such as Dr. King
  • Don’t be afraid to take on established offices of power, to struggle against them and make them become enabling resources for the movement
  • Yes, there are great risks of selling out, like becoming the boss at County, but in this there is also opportunity to inspire and catalyze and gain support for the struggle from below
  • Know when to move on
  • Sometimes you need to strike a balance between long-term commitments―which are lifelong―and tactical strategies―which have to be constantly rethought
  • Don’t be afraid to be labeled a radical or a socialist

Health Care in the USA is a Failed Experiment with Market Forces

Mardge Cohen and Gordy Schiff write of working with Dr. Young. For him, they say, “Organizing for political demonstrations, lobbying politicians, disrupting visits for key phone calls and meeting outside of the office, were all part of how he appreciated and served patients,” (177). They describe that Dr. Young saw that doctors and patients have to work together, saying

“the personalization of the individual and the destruction of the community, the emblems of our time, are conspicuously manifested in the role models enacted in the healthcare settings. A revised concept would envision changes in the role of physicians, nurses, and other health providers and in the role of the patient who would come to be regarded as the keeper of his or her own medical health,” (177-178).

Cohen and Schiff quote Dr. Young as saying about health care in the USA, that the “diagnosis is clear, we have a failed experiment with market forces,” (178).

Medicine is Only One of the Determinants of Health

John McKnight writes in the book,

“[At] that time Quentin and I had worked in Cuernavaca, Mexico, with Ivan Illich, the radical critic and social historian. Illich emphasized that health was not the product of medicine. Rather, medicine was one of the numerous determinants of health and that it often misled people to believe that there was something called a ‘health consumer.’ Illich argued that you could ‘consume’ medicine but it was primarily the social, cultural and economic environment that ‘produced’ health,” (199).

Everybody In, Nobody Out (203)

Dr. Young was one of the early supporters of Physicans for a National Health Program (PNHP), founded by Drs. David Himmelstein and Steffie Woolhandler. This is where I first, personally, encountered Dr. Young, seeing him speak at a conference and I quickly became a student member of PNHP. My thoughts about a national health program have fluctuated over the years. When I ran a private micropractice for 5 years, I became aware of how vast and intercalated into the health care system the insurance industry is. I also became aware that the insurance industry describes paying for someone’s health care “a loss.” This is a fundamental philosophical and linguistic problem. If health care is viewed as a loss then the obvious thing to do would be to try prevent loss – in other words, the primary motive health insurance companies is to prevent health care from occurring – that is the bottom line of health insurance companies.

Living and working in New Zealand for 3.5 years I had a chance to work and receive care in a nationalized health care system. I received care in the public and private systems (at the time around 5% of health care in New Zealand was through the private systems and private health insurance was closer to the cost of car insurance in the US). I had national health insurance, even when I had the equivalent to a green card, when I was on the permanent residency track (incidentally, as a functioning participatory democracy New Zealand law requires all citizens, permanent residents, and even those on the permanent residency track to be registered to vote). For primary care, there was a small copay based on how wealthy the community you lived in. The system worked great and people were happy with it. Everybody was in, nobody was out.

The pandemic is teaching us how “great” the US health care system is―it is not! The United States ranks 37th in the world in health care, despite spending far and away the most. Also see the arguments of PNHP for a single-payer plan. The pandemic shows us that the health of all depends upon the health of everyone. If the virus is spreading through the community, it doesn’t matter who you are if you get exposed to it. The health of the individual is the health of the community and the health of the community is the health of the individual – you cannot disconnect these things, we are all in this together. The time is right to work for health care for all. It is time to Make America Healthy Again.

Dr. Young’s Final Words: “The future can be bright, but only if we work to make it so

“The health system isn’t working in this country―fiscally, medically, socially, morally,” (216).

“Health care is a human right. There should not be market solutions in a life-and-death game,” (217).

“We need to redouble our efforts to extirpate racism from every aspect of the U.S. life,” (240).

“We need to pass single-payer national health insurance, an improved Medicare for all. We cannot rest until everyone, without exception, has unimpeded access to high-quality care,” (240).

“We need to radically reduce the huge wealth disparities in our country, where the vast majority of our economic assets are controlled by the ‘1 percent,’” (241).

“We need to get big money out of politics and elections,” (241).

“And we need a more rational, humane foreign policy,” (241).

“Over the years, I’ve been accused by right-wing circles of being ‘un-American’ for having advocated for a more humane society. These charges have left me unfazed. I am merely an American who has exercised my constitutional rights. I remain unbowed,” (241).

“To a certain extent this book chronicles, from a health viewpoint, the evolution of the tension between these two trends―toward justice or injustice. Whichever trend prevails will define the 21st century.”

“I retain a terrible reputation for excessive optimism. The glories of humankind’s ingenuity and inventiveness have not yet been exhausted. The future can be bright, but only if we work to make it so,” (242).

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