The Right Prescription

The Reformer’s Folly

We have been down the road to national health care before.

By 7.31.09

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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.

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About the Author

Ryan L. Cole writes from Indiana.