From the editorFrom the editor

‘The unfinished business is done’
A toast was raised to the NHS in last year's December issue of Clinical Medicine to salute a service where everyone, regardless of income, can obtain medical care free at the point of delivery – a remarkable achievement for any healthcare system.
This festive celebration was prompted by the efforts of the President of the United States of America, Barack Obama, and the Democratic party who, at that time, were battling to obtain approval in the Senate and House of Representatives for their Health Care Reform Bill which would provide health insurance for the first time for some 47 million Americans.
Of the 100 seats in the Senate, the Democrats had just enough (60) to muster the required two-third's majority to pass the bill. That was until the death of Edward ‘Ted’ Kennedy, on 25 August 2009, who had served in the Senate as the representative for Massachusetts for 47 years and who had been a staunch and longstanding campaigner for universal healthcare.
Many Americans were unhappy about the proposed changes since, of those who vote, 94% have private health insurance and of these 75% thought their medical insurance either good or excellent. While supporting the concept of affordable healthcare for all no one was keen to relinquish what they already had to solve the problem and the costs were perceived as a burden too far in an economic recession.
These strongly held views influenced the outcome of the election for Kennedy's successor which was won not by the Democrats but by Scott Brown, a Republican. As a result of this unexpected outcome, the Democrats ‘supermajority’ was lost.
The chances of passing the Health Care Reform Bill thus seemed remote and the spectre of previous unsuccessful attempts loomed large. In the face of such determined opposition, most would have given up the unequal struggle and turned their attention to other issues but not Barack Obama.
Some clues to his extraordinary persistence and tenacity can be found in his autobiography published in 1995 when he was only 34 years of age.1 After graduating in political science in 1983 from Columbia University, he sought work by writing to every recognised US civil rights organisation but without success. He eventually took a post as a research assistant to consultants working for a multinational corporation in New York principally to repay his student debts. His colleagues smiled indulgently when he discussed his future intentions of working to mobilise the poor to enable them to contribute positively in their own deprived communities.
After two years he relinquished this safe job and moved to Chicago as a trainee in a group organising urban blacks and suburban whites to work together around a plan to save manufacturing jobs in metropolitan Chicago using local churches as an effective institutional base. His extraordinary persistence and determination to overcome all the challenges and difficulties in achieving his goals in an area of extreme poverty, unemployment and hopelessness demonstrated that here was someone different who was not to be easily deterred.
This character building experience stood him in good stead. Despite all the odds stacked against him, and against determined opposition, the Health Care Reform Bill was eventually passed by the Senate on Christmas Eve 2009 and by the House of Representatives on 21 March 2010. The bill was signed into law in the presence of Ted Kennedy's widow, Victoria Kennedy. After the ceremony her son, Patrick, made his way to Arlington Cemetery where he laid a note on his father's grave: ‘Dad, the unfinished business is done’. This year we can but toast the triumph of improved access to healthcare at the point of delivery for all those previously excluded.
- Royal College of Physicians
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- Obama B.
From the editor
Farewell to ‘Conversations with Charles’
The first contribution of this long series can be found on the last page of the January/February 1999 issue of Clinical Medicine.1 In the introduction to the first piece the anonymous narrator ‘Coemgenus’ (or ‘Coe’ for short) declared that he was nearing the end of his consultant physician career after leading a busy and satisfying life in medicine with little interest in medical politics or outside affairs. He felt that the way ahead for medicine was now less clear to him than it had been in his younger days: a view for which many will find sympathy.
He described the pleasure of meeting up again after many years with ‘Charles’ whom he related was a contemporary of his at university to discuss current medical issues. Charles, who had gained a first in the arts, was self-assured and a radical thinker with a highly successful career in the City who had recently been recruited to the great and the good.
The medical topics discussed in this format over more than 10 years have ranged widely across all the major issues of the day in which Charles challenges each medical convention by adopting a new and original slant to the topic under discussion. In this valedictory editorial our debt of gratitude can be repaid by revealing the background to the series.
The personal qualities of ‘Charles’ are those to which the real author aspires and hopes that he has at least some elements in his own personality. Charles himself is purely fictional, unless he be the author himself, but the personalities of the other individuals and the stories for each essay have been drawn from real life experiences that the author has encountered during his career.
Could one individual really relate such a sustained fund of innovative and challenging ideas? The answer is a remarkable ‘yes’. A clue lies in the pseudonyms of ‘Coemgenus’ – the Latin for Kevin and the selection of the name ‘Charles’ as the alter ego.
With his permission, we can now reveal that the author throughout was Dr CK Connolly, first name Charles but known as Kevin. He worked as a consultant physician at Darlington Memorial Hospital for more than 30 years with a particular interest in respiratory medicine and infectious diseases. For the first time we can express our grateful thanks openly for so many entertaining and illuminating contributions over such a long period.
He in his turn would like to acknowledge the continued help and support of his colleague in Darlington, Dr Peter Trewby, and Dr Peter Watkins, the erstwhile journal editor, who have both acted as a sounding board in the drafting of each contribution.
- Royal College of Physicians
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