Don Draper’s health reform…

The big TV event this weekend was the season premiere of Mad Men, the AMC show that depicts the life of New York advertising executives and their families in the early 1960s.

It is smartly written and filmed to highlight the differences in everything from fashion to gender relations. Guest New York Times columnist Timothy Egan made a fascinating contribution about the changes in public health:

My parents and their friends were nicotine fiends, the women smoking even during late pregnancy. The high point of tobacco addiction was around 1964, when 42 percent of adults smoked. Today, the figure is less than 20 percent — a modern low.

I remember rattling around inside a station wagon filled with secondhand smoke. No seat belts, of course. And after the ride, we 6-year-olds reeked of Lucky Strikes.

Now, smokers are such pariahs that the actors on the set of “Mad Men” can’t even puff real cigarettes; they have to use herbal ones, or run afoul of the law.

If a driver of that station wagon had a drink or two before getting behind the wheel, so what? Drunken driving was a respected social skill. Last year, 11,773 Americans died in accidents involving drunken driving — tragically high, but down by more than 50 percent from a generation ago.

Roger Sterling, the silver-haired sybarite in the “Mad Men” ad agency, suffered a major heart attack, telegraphed from his first three-martini lunch. Today, coronary heart disease is still the leading cause of mortality in the United States, but the death rate from heart attacks is down 72 percent since 1960.

The brooding, unfathomable ad man at the center of the show, Don Draper, has high blood pressure. When his doctor asks how much he’s boozing, he admits, after some hesitation, to five drinks a day. He also has sexual problems, unable to match the passion of his stunning wife, a Grace Kelly look-alike who is a shrink session away from going full Betty Friedan.

…Is all of this progress, a march toward a more tolerant, equitable, less socially inauthentic society? Sure. Plus, Don Draper would have Lipitor for his heart and Viagra for his sexual troubles.

For a show in the 1960s, explicit politics and policy is only in the background on the show–in the premiere on Sunday, the only reference was to an ad executive bemoaning the 60%+ upper-income tax brackets of the day. And the serious health care issues that led to the passsage of Medicare and Medicaid in the late 60s are not shown.

But there’s a lot here to inform our health reform debate. It’s a useful reminder about the significant progress that there has been in not just sexual politics, but in the realm of prevention and public health:

* Tobacco control, which has included taxation, limiting its use in public spaces, medical research, educating young children, litigation, major public awareness efforts, and the overall changing of social mores.

* Drunk driving reductions through changes in law and increases in penalties and enforcement, as well as a major public education effort that includes changing its social acceptability.

* Seat belts took a combination of ensuring that they were provided as standard in cars, and then a variety of public education strategies to get people to use them.

These things, by themselves, have saved untold lives and increased are life expectancy. Like the cause of gender and racial equality, these didn’t happen overnight or without struggle. Each of these efforts were long, concerted, multi-year, multi-pronged campaigns by many players. And it’s not over yet: For example, while the three martini lunch may not be as prevalent, we may not have some to terms with the full health impact of alcohol, so there is more work to do for groups like the Marin Institute.

The current conversation on health insurance reform, as the President not calls it, is less about people’s health, and more about the health of their finances, and the health of the economy. That’s not a bad thing: it’s essential to prevent people who go bankrupt for medical reasons, or to remove the economic insecurity that so many people feel when they need care, either for age or accident.

There are elements of the reform bills that focus on prevention, doing more research, focusing on public health efforts, and making sure that there are no financial barriers to screening and preventative care. Here’s a prevention fact sheet on H.R.3200:

Beyond the policy specifics, my hope is that once we finally make a public policy commitment for quality, affordable health care for all, that such a changes creates a platform and investment to move toward a healthier environment and society.

So I can imagine another form of entertainment 50 years from now, where our current technology looks quaint, our fashion looks sophisticated, our music is nostalgic, and some of our current diet and lifestyle choices, as well as current policies and industry practices, look as unhealthy and silly as the smoking and drunk driving scenes in Mad Men today.
Health Access California promotes quality, affordable health care for all Californians.

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