Dr. Beatrix Hoffman is Professor of History at Northern Illinois University and guest curator of NLM’s newest exhibition, For All the People: A Century of Citizen Action in Health Care Reform. Health care reform has been associated with presidents and national leaders, but communities, workers, activists, and health care professionals have made their voices heard in the debate about whether and how to make quality health care available to all. For all the People tells the lesser-known story of how movements of ordinary citizens helped shape the changing American health care system. As open enrollment begins at HealthCare.gov, Circulating Now interviewed Dr. Hoffman about her work.
Circulating Now: Tell us a little about yourself. Where are you from? What do you do? What is your typical workday like?
Beatrix Hoffman: I’m Professor of History at Northern Illinois University in DeKalb, IL. NIU is a public research university located in a small town, but not far from Chicago. I teach mostly U.S. history and history of medicine. This semester I am teaching a new course on Latino History, which is related to my current research project on access to health care for immigrants and migrants. I have a group of incredibly enthusiastic and motivated students in that class, and I always look forward to it. I am also teaching our Senior Thesis seminar, guiding students who are working on full-length original historical research projects. As well as teaching, on a typical day I will meet individually with students, attend committee meetings, prepare talks and conference papers, and if I have time I usually try to get some research or writing done.
CN: You’ve just finished work on a new exhibition here at the National Library of Medicine, what sparked your interest in curating For All the People: A Century of Citizen Action in Health Care Reform?
BH: For a while, I’ve been wanting to find some way to share my research with a larger audience than can be reached by academic publishing and conferences. To be honest, I had never thought about an exhibition format until I was contacted by Patti Tuohy at NLM. I was very excited, but also worried because I don’t have a lot of experience working with images, as opposed to words. But it turned out that the story of citizen action in health care reform, which I have been studying for over a decade, is one that can be told very powerfully with photographs and other visual items. I wanted to take on the challenge of making a historical argument and summarizing a fairly complicated narrative with images and relatively few words.
CN: While working on this project were you drawn to any particular individual’s story?
BH: There are so many fascinating characters that it’s difficult to choose, but I was particularly intrigued by Leonidas Berry, an African-American physician who was a leader in the medical civil rights movement from the 1950s through the ‘70s. I had studied him a little bit before, but being able to look at his archives at NLM more deeply made me realize that his contribution to civil rights and health care equity has been hugely underappreciated. Berry not only led campaigns against hospital segregation and discrimination by the American Medical Association, but he also pioneered the concept of the remote area medical service. In the early 1970s he organized a group of Chicago doctors and nurses who chartered an airplane and made regular flights to Cairo, in the very southernmost part of Illinois, to provide medical care to the impoverished community there. I hope his accomplishments will get more recognition.
CN: How did you originally become interested in the history of health care reform?
BH: I lived in the U.K. while studying for my Master’s degree. One time I had to go to the doctor, and that’s when I found out that in the British system, no one ever received a bill for medical care. The question of why the United States was (and is) the only developed country that allows its citizens to go without health insurance has preoccupied me ever since.
CN: You’ve studied attempts at reform in the American health care system for a long time. What’s different now with the passage of the Affordable Care Act?
BH: As of 2015, the percentage of Americans without health insurance dropped from 20% to 13%. Millions have been able to obtain affordable coverage for the first time, and millions more could be covered if all states agreed to participate in the law’s Medicaid expansion (currently 24 states do not). Probably the biggest change is to the insurance industry itself. Companies are no longer allowed to refuse coverage to people because of their health condition, gender, or other factors. This is a fundamental change in how U.S. insurance companies do business. But, because the Affordable Care Act subsidizes private insurance rather than creating new mechanisms for health coverage, I would argue that the central problems of the U.S. health system remain the same: fragmentation, complexity, unequal access, high copayments and deductibles, significant flows of taxpayer money to private businesses, and especially a continuing lack of universal coverage.
CN: What inspires you in your work and what do you hope readers will gain from it?
BH: I am inspired by the many examples of people who took major risks in the fight for health care justice, from factory workers in the 1910s to people with AIDS in the 1990s. My hope is that For All the People will increase awareness of ordinary Americans’ contributions to health reform debates. If we recognize that change can be created from the bottom up as well as the top down, maybe more people will get involved in creating a fairer and more just health care system.
Courtesy National Archives and Records Administration
Healthcare in the United States has been a most divisive issue for all.The current costs are rising.We still have people unable to afford the costs to begin with.;the program while ambitious shifts costs to many people barely able to pay for it.Technology keeps advancing along with cost.Many of our government leaders wish it repealed.Perhaps,we should better evaluate other countries methodologies for making it work.