Monday, Nov. 30 marked yet another beginning to yet another round in the century-and-a-half-old debate over the public role in the guarantee of healthcare to all United States citizens. If you are a betting sort, the smart money says that you had best be an observer of history and be very careful of how much of your hard-earned wages that you place on the success of the current efforts to pass any meaningful legislation during this current round. One observation at the outset is that the roles of the actors on all sides of this issue are eerily the same as they have been over the course of time. While many of the people themselves have departed the scene Republicans are still Republicans, Democrats are still Democrats, the American Medical Association is still the American Medical Association and the pharmaceutical companies are still the pharmaceutical companies.
A brief examination of the history of healthcare and related social legislation should be instructive. While various approaches to national health insurance in some form had been floated since the late 1800’s, little of significance gained any real traction until the Franklin Roosevelt presidency began in 1932. Enough “noise” had been made prior to that time by those who recognized a problem that the American Medical Association House of Delegates had declared itself in opposition to government health insurance in 1920. In a Fireside Chat of June 1934, President Roosevelt proposed to use government to “establish a means to provide sound and adequate protection against the vicissitudes of modern life – in other words social insurance.” In the next sentence, FDR alluded to the fact that “timid people” will try to label the effort with strange names such as “Fascism,” “Communism,” “Regimentation” and “Socialism.” On the following day, President Roosevelt established the Committee on Economic Security to prepare recommendations for legislation that would lead ultimately to the passage of the Social Security Act, which was signed into law Aug. 14, 1935. By way of setting the record straight, the vote count in the U.S. House of Representatives was 365 in favor and 33 against. Of that number, 81 Republicans voted yes while 15 Republicans were opposed. In the Senate, the vote was 77 in favor and six opposed. Sixteen Republicans Senators favored Social Security and nine were opposed or didn’t vote.
Harry Truman was next in the batter’s box in an effort to gain national health insurance. His experience seemed to indicate the beginning of a pattern that exists until this day. To begin with, the American Medical Association dusted off the “socialized medicine” label.
Republicans and Southern Democrats immediately mounted opposition, and perhaps most importantly private business and industry began offering insurance as a major fringe benefit in lieu of wages. Public opinion swung toward this broader private sector coverage and the Republican takeover of Congress in 1946 virtually ended this round of debate over healthcare reform.
The effort to bring about what we now know as Medicare entered the legislative stage early in the administration of John F. Kennedy. The American Medical Association launched an all out effort against what it labeled “the most deadly challenge ever faced by the medical profession.” Interestingly in the midst of this ultimately unsuccessful effort during the Kennedy administration, a New York Times columnist said of Kennedy that he “lacked the overall bearing” of other powerful Presidents and that he seemed “insecure.” Former President Eisenhower said the Kennedy administration was “foundering.” Does this sound familiar? By contrast using his characteristic force of personality and playing to the legacy of the late President Kennedy, President Lyndon Johnson pushed through the passage of Medicare and signed it into law in 1965.
In 1993, President Bill Clinton, in an effort headed by his wife, Hillary, launched yet another major effort at healthcare reform. Conservatives and the healthcare industry mounted a furious campaign symbolized by the fictional couple, Harry and Louise, and halted the 1,000-page healthcare reform bill that collapsed under its own weight. Many Democrats jumped ship and others offered alternatives. New York Democrat Daniel Patrick Moynihan stated, perhaps prophetically, that “there was no healthcare crisis – there is an insurance crisis.” Before things could be repaired, in 1994 the Republicans captured the majority in Congress just as they had under Truman in 1946.
Now comes the Obama version of the healthcare reform effort. Many of the same characteristics that have attended this debate over the past century are present for this round and they have hardly changed at all.
Republican opposition is significant and in this case united as never before. President Obama’s leadership in this effort has been portrayed as lacking in force and foundering just as was the case made by the critics of Kennedy. Congress in the House and Senate respectively has created two massive bills of over 1,000 pages that are threatened with collapsing under their own weight as was the case with the Clinton administration’s proposal, and the specter of a Republican takeover of the House and Senate looms on the 2010 horizon with 1946 and 1994 serving as reminders of that possibility. A prediction from this corner with the aid of history holds that once again comprehensive healthcare reform legislation is doomed to failure.
Dr. William Martin Wiseman is director of the John C. Stennis Institute of Government and professor of political science at Mississippi State University. Contact him at firstname.lastname@example.org.