When President Lyndon Johnson signed Medicare into law on July 30, 1965, he faced a year of nearly crippling attacks from groups like the American Medical Association (AMA) and conservatives who feared an onslaught of “socialized medicine” and threatened to boycott the new program.  Although memories of the Medicare battle have faded over 45 years, similar battles could be fought over the passage of the Patient Protection and Affordable Care Act. This is the opinion of Dr. Atul Gawande, general and endocrine surgeon at Boston’s Brigham and Women’s Hospital and Associate Professor of Surgery at Harvard Medical School.

Writing in The New Yorker, Gawande notes that because most of the healthcare reform act’s provisions phase in at a slower pace than did Medicare, it is even more open to attack.  “The context, of course, is different.  The AMA endorsed the legislations; hospital associations were supportive.  Once the public option was dropped, most insurers favored the bill.  The medical world will wage no civil resistance.  This time, the threat comes from party politics.  Conservatives are casting the November midterm elections as a vote on repealing the health-reform law.  If they regain power, they are unlikely to repeal the whole thing.  Instead, they will try to strip out the critical but less straightforwardly appealing elements of reform - the requirement that larger employers provide health benefits and that uncovered individuals buy at least a basic policy; the subsidies to make sure that they can afford those policies; the significant new taxes on household incomes over $250,000 - and thereby gut coverage for the uninsured.”

Gawande notes that reform is hardly a government takeover of healthcare, as many opponents contend.  Rather, its success relies on communities and clinicians.  “We are the ones to determine whether costs are controlled and healthcare improves - which is to say, whether reform survives and resistance is defeated,” according to Gawande.  “The voting is over, and the country has many other issues that clamor for attention.  But, as L.B.J. would have recognized, the battle for healthcare reform has only begun.”