The Reformer’s Folly
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Barack Obama’s rush to reform America’s health care system is
stalled as legislators and citizens grapple with the fiscal and
political ramifications of the $1.5 trillion bill now on offer in
Congress.
With Democratic majorities in the House and Senate plus his
personal popularity and much acclaimed powers of persuasion, it
astonishes that barely six months into his presidency, health
care reform, one of Obama’s paramount domestic goals, is in
peril.
Adding to the surprise, the plurality of Americans — 71 percent
according to a recent Gallup Poll, believes the country’s health
care system should be overhauled. But reform and statism are not
mutually exclusive. And Americans have never been comfortable
with the notion of socialized medicine, which many believe
despite Obama’s protests otherwise, will be the ultimate product
of the coming “reforms.”
In fact, for nearly a century presidents have been promising to
cure the country’s ills with government-run health care and at
just about every instance their schemes have been dead on
arrival.
Franklin D. Roosevelt was the first to dream of national health
insurance. (Though his cousin Theodore’s 1912 quest for the White
House included a call for the “protection of home life against
the hazards of sickness.”) In 1934, Roosevelt predicted the
nation would “come to this form of insurance soon or later.” The
president favored sooner: the Social Security Act, as initially
envisioned included national health insurance. This, however,
would have made the already controversial program an even harder
sell. Straining to hold back the grandiosity of his ambitions,
Roosevelt scrapped the health care concept. When the Social
Security Act was singed into law in 1935, all that survived of
Roosevelt’s original vision were small grants to states for rural
and handicapped health programs.
The idea of nationalized health care languished until the next
decade when Roosevelt’s successor, Harry S. Truman renewed the
call for universal coverage in 1945. Senators Robert Wagner and
James Murray and Rep. John Dingell (who had previously
collaborated on an insurance proposal) then drafted legislation
that would federally subsidize hospital construction, institute
national health care standards and create a national health
insurance program in which citizens would cough up a monthly fee,
while the government would pay doctor bills and compensate for
lost wages.
The resulting bill, known as W.M.D. (named for Wagner, Murray and
Dingell) arrived in 1946. Even though Democrats held both of its
houses, the legislation sputtered and died in Congress as its
opponents’ criticism of the health insurance language of the bill
as socialism resonated with the public in the midst of the Cold
War. Truman repeatedly renewed the call for national health
insurance during the remainder of his presidency but had little
to show for his efforts when he returned to Missouri in 1953.
A decade later in Missouri, and with Truman in attendance,
President Lyndon B. Johnson signed the Social Security Act of
1965, creating Medicare and Medicaid. These programs represent
the first large-scale government run health care initiatives in
U.S. history, though they were less ambitious in scope – covering
only the elderly and some of the nation’s poor — than previous
proposals.
They also represented a new incremental strategy that took into
account the public’s resistance to government involvement in
medicine and aimed to assemble nationalized insurance bit by bit,
while avoiding any associations with socialized health care. Even
the legislation’s language stated “Nothing in this title shall be
construed to authorize any Federal officer or employee to
exercise any supervision or control over the practice of
medicine…”
Still, Johnson and House Ways and Means Chairman Wilbur Mills
struggled mightily to secure the bill’s passage in one of the
most liberal and Democratically dominated Congresses in history.
In fact, Medicare and Medicaid were such risky political and
fiscal propositions that Johnson fudged their cost and
feasibility and pitched them as modest and affordable
interventions to help vulnerable Americans.
The programs have grown exponentially since their creation and
belied all of their creators’ most optimistic projections: for
example, in 1965 the government estimated that Medicare Part A
(the program’s inpatient hospital care provision) would cost $9
million by 1990. The actual cost was $66 billion. Medicare is now
shouldering an $84 trillion unfunded liability and will be
bankrupt by 2017.
But Medicare and Medicaid were immediately well received. Because
of this, in the early 1970s, Democrats sought to expand the
program to cover the entire country. With this in mind, President
Richard Nixon, who had endorsed a national health insurance plan
as a Representative from California in the 1940s, used his fifth
and final State of the Union Address to propose a “sweeping new
program that will assure comprehensive health-insurance
protection to millions of Americans who cannot now obtain it or
afford it.”
Introduced in February 1974, Nixon’s plan, the Comprehensive
Health Insurance Act, would be financed jointly at the federal
and state level to provide coverage for the nation’s uninsured.
But it would do so by building off of insurance plans instead of
creating a costly new bureaucracy. Nixon was careful to
distinguish his plan from those “that would put our whole health
care system under the heavy hand of the Federal Government.”
After a series of compromises, the plan was eventually meshed
with aspects of competing proposals in Congress, but organized
labor, hoping to broker a better deal with a new and presumably
more liberal Congress after the 1974 midterm elections, or a
Democratic president after the 1976 election, refused to support
the plan. The proposal collapsed as the Watergate scandal
subsumed the presidency and, for the moment, the prospect of
universal coverage.
Enter the Man from Plains. Jimmy Carter’s 1976 bid for the White
House included a pledge to create a “comprehensive program of
national health insurance.” But battling stagflation,
in-house politicking — especially between the Department of
Health Education and Welfare and the White House, and continued
opposition to a national plan, Carter moved slowly on health care
reform — too slowly for some. He initially proposed any reforms
be phased in and implemented gradually. Senator Edward Kennedy,
who then, as now stood as Congress’ chief advocate of a
nationalized health care, rejected this approach and introduced
his own plan for universal coverage.
Carter countered with a plan of his own — HealthCare, which
featured a large role for insurance companies minus universal
coverage. Carter and Kennedy cobbled up a compromise, but their
efforts were ultimately fruitless. As 1980 approached the nation,
preoccupied with a crippled economy and foreign affairs, was not
interested in bloating the federal budget or increasing taxes;
the appetite for a potentially budget busting national health
care plan was, again, not there.
The liberal dream of a socialized health care laid dormant for
the next decade until Bill Clinton guided the Democrats back to
the presidency in 1992. Once in office, he delegated the task of
creating a national health insurance plan to the Task Force on
National Health Care Reform, an advisory board headed by the his
wife, Hillary. The result, the Health Security Act was a
dizzyingly complicated 1,342 page bill featuring a mandate for
all U.S. citizens to purchase or acquire health insurance. The
Clintons’ efforts were doomed by secrecy, inept politicking and a
well-orchestrated Republican opposition which yet again
successfully tapped into the public’s resistance to government
intrusion and suspicion of the bill’s feasibility.
This brings us to the current president’s problems. During the
2008 campaign, Obama, aware of Americas’ long-standing position
on the issue, ran commercials disingenuously claiming the
candidate’s opposition to any plan that equaled “government run
health care, higher taxes.”
But now as Obama’s aims become clear and the details of his plan
are laid bare — $800 billion in new taxes, rationed care,
millions of citizens displaced from their current insurance
plans, and an overarching “bureaucrats-know-best” approach to
medicine, the country is growing increasingly uncomfortable with
the president’s agenda.
This is a familiar turn of events. For decades, despite the
supposed aligning of the stars, majorities in Congress and the
efforts of their best and brightest, proponents of
government-managed care have repeatedly failed to impose their
will on the country.
If Democrats are once again unable to realize their goal, the
blame, as it always is, will be placed on the fear-mongering
smear campaigns of the Republican Party and the medical industry.
This mythology never takes into account colossal price tags,
exorbitant taxes, unintelligible proposals and the simple (and to
some unfathomable) notion that Americans with their unique
history of self-reliance have never desired and still do not want
socialized medicine and its accompanying restrictions on personal
freedom and reductions in health care quality and innovation.
As Obama is now all too well aware, government-run health care
has never been easy medicine for Americans to swallow.
