From the GP who made house calls in the middle of the night to the FP who testifies before Congress, Academy members have been committed to each individual's right to health care.
"The GPs of old were there for everybody, all the time," says AAFP Board Chair Douglas Henley, MD, of Fayetteville, NC. "The ideal we have is that the GPs took care of patients throughout their life cycles. They took care of the family regardless of its socioeconomic status or ethnicity or race; they took care of all the patients who presented at their front door."
Dr. Henley says FPs of today aspire to the same goals but in the context of a complex, expensive health care system.
By the late 1980s, as health care costs spiraled and the number of the uninsured grew to about 37 million, the Academy deliberated whether to call for "universal enfranchisement." The 1989 Congress of Delegates said the FP's role as patient advocate extends logically to Americans without medical insurance. The delegates made the AAFP the first national medical organization to call for universal coverage.
That same year, acting on an AAFP resolution and other recommendations, the AMA committed itself to making access to care for the uninsured a high priority for the US Congress.
Then in 1992, the AAFP Congress unanimously adopted "Rx for Health: The Family Physicians' Access Plan." It called for a personal physician for every American, universal health insurance coverage through employers and public programs, and a basic benefits package (including preventive care) for all insurance plans.
"Rx for Health" caught the attention of the US Congress and the administration of President Bill Clinton. Key elements of the AAFP plan were incorporated into many reform bills, and policy-makers finally began talking about generalism and health care reform in the same breath.
The nation's tumultuous debate over the health care system in 1993-94 gave AAFP the unprecedented opportunity to meet with the administration and testify before congressional panels as they grappled with health care reform. However, with the failure of comprehensive reform in 1994, the issue of universal coverage faded from public attention.
In 1996, as AAFP president, Dr. Henley alerted FP leaders at the State Officers' Conference that the number of uninsured Americans by then exceeded 42 million. He asked them to put the issue back on the national agenda, and he repeated that challenge as he visited chapters and spoke to the AAFP Congress.
"I'm not talking about national health insurance and a government-run program," says Dr. Henley. "A pluralistic system is the only way this country can cover everyone. A government-run program is not going to work, and the private market itself is not going to achieve universal coverage. It's got to be a joint venture."
Taking an important step in insurance reform, last year Congress passed legislation introduced in the Senate by Nancy Kassebaum, R-KS, and Ted Kennedy, D-MA. The measure, endorsed by the AAFP, guarantees that health insurance is available to people who lose or change jobs. It also blocks insurance companies from denying coverage to people with pre-existing conditions.
Next, the AAFP will seek coverage of all children and pregnant mothers. "We'll take the incremental approach and remember what our target is: coverage for everybody," says Dr. Henley.