“Obama Care” Part 1, The History


Since President Obama has been re-elected, I decided that I had better educate myself on the question of the Health Care Reform Act and find out what is really at stake.  I do believe that the only way the President will get the support he needs to make this initiative successful is if he and his Administration educate the public with the same energy and coordination that they used for his election and re-election.  For my part, I will begin with the history of the universal health care question in our country and move forward.

Many people think that the whole question of universal health care was “pushed” on us  by “this” president.   Untrue.  Universal health care has been a topic of discussion since the turn of the century — the 20th century.  Yes, since the early 1900s.  Why is it that the idea of universal health care has not been embraced by our country, the only advanced nation in the world not to have universal health care?  The answer to that question has many components.  Jill Lepore, in an article  she penned December 7, 2009 for the New Yorker, wrote that a group of economists which included Louis Brandeis, Jane Addams and Woodrow Wilson formed a committee they called the Committee on Social Insurance.  By 1915, the committee had drafted a bill to provide universal medical coverage.  At the time, the American Medical Association enthusiastically supported the idea and by the end of 1916, the idea was presented to Congress for their approval.

According to Lepore, part of their presentation lauded Germany as the great example to be emulated.

“Germany showed the way in 1883,” Fisher [one of the committee members] told his audience. “Her wonderful industrial progress since that time, her comparative freedom from poverty . . . and the physical preparedness of her soldiery, are presumably due, in considerable measure, to health insurance.”

However, in April 1917, the United States declared war with Germany,  killing, along with some German soldiers, any move towards Universal Health Care which was now being correlated as a product of Germany.

In Lepore’s article, we learn that:

In California, where the legislature had passed a constitutional amendment providing for universal health insurance, it was put on the ballot for ratification: a federation of insurance companies took out an ad in the San Francisco Chronicle warning that it “would spell social ruin to the United States.” Every voter in the state received in the mail a pamphlet with a picture of the Kaiser and the words “Born in Germany. Do you want it in California?” (“If you are opposed to a thing these days,” one frustrated health-care advocate wrote, “the cheapest way to attack it is to call it ‘German.’ ”) The people of California voted it down. By 1919, John J. A. O’Reilly, a Brooklyn physician, was calling universal health insurance “UnAmerican, Unsafe, Uneconomic, Unscientific, Unfair and Unscrupulous.”

Hm.  This certainly sounds familiar, although these days, the word German has been replaced with the word socialist.

Fast Forward to Franklin D. Roosevelt and the New Deal.  Once again, universal health care was bandied around as a right of all citizens.  But opposition came, in the form of Southern Senators (who were mostly Democrats at the time, because Abraham Lincoln had been a Republican), concerned about the implications that a National Health Insurance (NHI) might have in their segregated societies.  They aligned themselves with Republican senators and brought the American Medical Association (AMA) into the fold to put a block to this.  President Roosevelt, concerned that other New Deal reforms would not pass if he pushed too hard on NIH, dropped it.

However, after World War II ended, President Truman tried to implement the national health insurance once again. His plan proposed a single insurance program that would cover all Americans with public subsidies to pay for the poor.   Once again, according to an article published by the Kaiser Foundation:

Southern Democrats in key positions blocked Truman’s initiative, partly in fear that the federal involvement in health care might lead to federal action against segregation at a time when hospitals (in the South) were still separating patients by race. [The irony of the fact that it was President Obama who successfully brought universal health care into law is not lost on me.]

Also “an increasingly powerful AMA opposed National Health Insurance believing that physicians would lose their autonomy, be required to work in group practice models and be paid by salary or capitated methods.  In addition, business and labor groups were not supportive, nor was the emerging private health insurance industry. “

Now the opposition was becoming stronger.  The area of health care was being recognized as a potentially huge money making enterprise by the business class.  But the government continued to plug away at the idea of universal healthcare.  President John F. Kennedy presented the concept in the form of health care coverage for all those on Social Security.  This was in 1962.  President Lyndon B. Johnson was able to pass legislation creating Medicare/Medicaid programs to provide comprehensive health care coverage for people aged 65 and older, as well as for the poor, blind, and disabled in 1965.  At this point, healthcare related spending started to skyrocket.  Health care became a lucrative business.

In 1971, confronting the escalating costs of healthcare, President Richard M. Nixon backed a proposal that would require employers to provide a minimum level of health care for their employees, while maintaining competition among insurance companies, keeping medicare/medicaid for those over 65 and creating a pool insurance coverage for self-employed individuals.  Senator Teddy Kennedy at the time was promoting a universal health care coverage directed and financed entirely by the government.

In hindsight, President Nixon’s proposal might have helped to contain health care costs.  The issue that was being challenged by Senator Kennedy was that President Nixon’s program supported private insurance companies as the providers of health insurance.  Kennedy’s proposal would take health care out of the private sector.

The debate that occurred between President Nixon and Senator Kennedy probably best epitomizes the struggle our country has had throughout its existence [go back to the acrimonious exchanges between Thomas Jefferson and Alexander Hamilton].  The debate has always centered around the rights of the citizenry and the rights of businesses to thrive and keep this country moving forward economically.  What the debate never seems to quite latch onto is that there are some areas that are service areas by nature and other areas that fit under the intent of business.  Health care is a service area.  It should not be a money making enterprise.  When the focus is on making money, the focus is no longer on service.    [to be continued....]

© Yvonne Behrens, M.Ed  2012