Sun Blogs: SunShine
Healthwatch: 75 Years of “Imminent” U.S. Health Care Reform
October 5, 2009 - 11:00pmWith President Obama’s confident rhetoric, a pep rally for doctors at the White House on Monday, and a Senate vote on the horizon, health care reform seems more imminent than ever. The rising cost of health care, the aging population, and a newly formed White House Office of Health Reform may be structural factors contributing to the likelihood of the reform. However, it is far from the first time that politicians have sold the American Public on the idea of impending reform to the American Public.
And despite bold proposals dating 75 Years, comprehensive reform has never happened.
Although it was never made public, Franklin Roosevelt’s Committee on Economic Security first explored the possibility of a National Health Insurance program (NHI) in 1934. The need for health insurance seemed imminent: during the Great Depression, thousands of Americans were impoverished as a direct result of their medical care, income disparities in access to health care had widened. The reform – which called for a state-run individual mandate system which states could opt into, federal subsidies for care, and minimal care standards – was not presented in 1934 because Roosevelt believed that its controversial nature might defeat the entire Social Security proposal. Nor did it pass in 1937 when a second committee convened to advance reform, this time because of resistance from the new private insurance market, various labor groups, and the increasingly powerful American Medical Association, which equated government insurance with reduced physician autonomy.
After World War II ended in 1945, President Truman called upon Congress to pass domestic health care reform: this time nationalized, universal, and administered like Social Security benefits. However, post-war politics and Republican control of Congress defeated the proposals with claims that nationalized insurance would lead to “socialized medicine” at a time in which fear of socialism and communism was commonplace. Again, imminent reform was a pipe dream.
Finally, in 1964, President Johnson used his landslide victory over Barry Goldwater and a strong Democratic Congressional majority to enact Medicare and Medicaid, the first national health insurance legislation. At its inception, Medicare promised to pay for hospital care, and home health care for all senior citizens in Part A, and physician care in optional part B. Medicaid covered some types of care for certain groups of poor and disabled Americans.
But reform sentiment was only temporary. Single-payer reform plans with no plans for cost-sharing under Edward Kennedy throughout the 1970s failed due to an overwhelming array of options and concerns over cost containment.
In the 1980s and early 19990s, health care costs grew significantly and by 1990, health care spending comprised 12% of the GDP. Polls in the early 90s revealed that Americans were increasingly worried about not being able to afford future medical bills. Clinton attempted to pass the Health Security Act in September 1993, which included universal coverage, employer and individual mandates, and private insurance competition – similar to the options currently on the table this fall. This, too, failed, presumably because of Clinton’s lack of electoral mandate and the complexity of the 400-page plan, which prevented activism. However, Congress passed incremental reform in 1997 in the form of the Children’s Health Insurance Program (SCHIP), which builds upon Medicaid to provide coverage to low-income children.
History reveals that health reform is by no means a new story. And, despite the fact that for over 75 years, it has been an issue championed by both citizens and politicians, the 20th century saw only occasional incremental reform.
Perhaps this year – and the 21st century – will be an exception.