Howard Markel: Commitment to provide health care for all has long, twisted history
Obama found success on health care while many others tried and failed, he says
Editor’s Note: Howard Markel, a professor of medical history and pediatrics at the University of Michigan, is author of the forthcoming book “The Kelloggs: The Battling Brothers of Battle Creek” (Pantheon Books). The opinions expressed in this commentary are solely those of the author.
“The test of a first-rate intelligence,” F. Scott Fitzgerald wrote, “is the ability to hold two opposed ideas in mind at the same time and still retain the ability to function.” Maybe so. But that doesn’t explain how so many Americans adore their Medicare but still express bitter hatred for government intervention in health care.
Let more-partisan pundits dissect the motivations of those Republicans in Congress who voted more than 60 times to repeal the Affordable Care Act when Barack Obama was President, but now are treading far more lightly to repeal, but not replace, Obamacare with Donald Trump in the White House.
The fact is the government’s commitment to provide health care for all Americans has a long, twisted history, one worth reviewing in these perilous times in which more than 28 million Americans may find themselves suddenly uninsured.
Most historians of national health care programs point to the year 1883 and credit Otto von Bismarck, the first Chancellor of Germany, with developing a policy wherein public monies and contributions from workers were pooled and used to provide health care and reimbursement for lost wages to workers who became ill or injured. By 1911, when Great Britain first implemented a program similar to Germany’s, most major, developed European countries could boast health care policies that protected their citizens.
Not so the United States of America.
Although many American politicians like to sing the praises of Theodore Roosevelt as the author of such a policy during his ill-fated run for the presidency in 1912, there were many state officials, health-related philanthropies and other progressive thinkers during the first decades of the 20th century who advocated adopting protective health plans such as those in Germany and Britain.
Even the conservative American Medical Association once sponsored the work of many state-based health policymakers to conjure up workers’ compensation programs and increased access to health care facilities for citizens of all social stations and walks of life.
But as the nation prepared to enter World War I, there was little desire among most Americans to emulate any policy that originated in Germany. There was also a financial component to this opposition, with respect to the medical profession: Many doctors worried that if the federal, or even state and municipal governments provided free or reduced-cost health care it would erode their earning power and their autonomy to practice medicine as they, not the government, saw fit.
After World War I, during the 1920s and extending into the depths of the Great Depression, a reform movement once again rose, combining philanthropies and progressive policymakers at all levels of government, arguing that the country needed a national health care program. Such ideas were, in fact, initially written into the Social Security Act of 1935, but Franklin Roosevelt took that clause out of the bill, fearing that opposition from the AMA and others might put the kibosh on the much-needed pension program for the elderly.
Although there were failed attempts in the House and Senate to pass a health care bill, it was Harry Truman, at the close of World War II, who championed the cause with five primary goals: 1) increasing the number and capacity of American hospitals; 2) increasing public health, children’s and maternal health services; 3) increasing federal funding for medical research and education; 4) finding the means to reduce the costs of medical care for the average working American and the poor; 5) and, à la Bismarck, developing the means to reimburse the lost wages by those who became seriously ill.
As he made these proposals in 1945, and again in 1947, Truman repeated he was not proposing “socialized medicine” because “the American people want no such system.”
Nevertheless, the boogeyman of socialized medicine, irresponsibly and incorrectly raised by the AMA and its allies, carried the day, and Truman’s plan was relegated to the dustbin of history. He did have some success with the passage of the Hill-Burton Act of 1946, which tackled his first goal of increasing the nation’s hospital capacity, especially in rural and suburban areas. But, as Truman wrote in his 1956 memoir, “Years of Trial and Hope”: “I have had some bitter disappointments as President but one that has troubled me most, in a personal way, has been the failure to defeat organized opposition to a national compulsory health insurance program.”
It would not be until 1965 that Lyndon B. Johnson successfully rammed Medicare and Medicaid through Congress and signed a national health insurance program for both the elderly and the poor into law. The signing ceremony took place in Independence, Missouri, in honor of Truman, whom Johnson called “the real daddy of Medicare.”
No one, it seems, wants to recall Bill and Hillary Clinton’s 1993 attempt to revolutionize and reform American health care. Remember Bill Clinton’s famous State of the Union speech when he held up a “health security card” that he hoped would provide every American man, woman and child access to health care and preventive services? The plan was predictably trounced by Republicans, Libertarians and the powerful insurance industry. And House and Senate Democrats only made things worse by refusing to get behind “Hillarycare,” confusing matters by introducing their own convoluted health care plans. The Clinton plan was dead before the ink on the proposal could dry.
Sadly, at the expense of the health of all our citizens, it would be another 45 years after LBJ’s historic signing before the passage of the Affordable Care Act of 2010, which achieved even more of what Truman and many others had sought for so long and which the Republican House, Senate and President are now threatening to dismantle.
The plaintive question this historian and physician is compelled to ask is how much longer will we have to wait before every American citizen is guaranteed the right to health and access to health care?