Today, we stand at the brink of historic health care legislation. President Obama has brought us to this point less than seven months after inauguration. To understand how remarkable that is, it is helpful to review a little history and remember the liberal heroes who got us to this point.
UPDATED: Thanks, Meteor Blades: 1933: The Committee on the Costs of Medical Care published its reports. FDR did not push for massive health care coverage - remember, there was hardly ANY health insurance then - but there were some limited innovations.
The National Health Care Conference of 1938 encouraged local and state efforts to develop health reform. Health care coverage was briefly provided by the Farm Security Administration and the Federal Emergency Relief Agency, covering more than a million people.
The American Medical Association (AMA) supported the FSA and FERA programs because they recognized the preeminence of organized medicine. The AMA flexed its considerable political muscle throughout the FDR period in an effort to preserve its monopolistic position. In the words of James J Means, MD, in his presidential address before the American College of Physicians in 1938: "The behavior of the AMA is political. It is partisan behavior. It champions a cause. At the present time the cause is something close to standpatism."
November 1945: President Truman asks Congress to enact a universal health care plan. The AMA brands the Truman plan as "socialized medicine," giving birth to the term that would be used for decades. Republicans and southern Democrats defeat the bill in Congress.
1952: President Truman scales back his plan, advocating national health care only for elderly people receiving Social Security. The first Medicare bill is introduced in Congress. The AMA immediately announces its opposition and leads the fight that keeps the bill from advancing.
1958: Representative Aime Ferand (D-RI) introduces a Medicare bill in the Ways and Means Committee. It draws significant support in Congress and among the public. The AMA, frightened by the growing popularity of the bill, triples it's lobbying budget and leads a ferocious attack on the plan. The bill does not make it out of committee.
1960: The Kerr-Mills bill is introduced by Representatives Robert Kerr (D-OK) and Wilbur Mills (D-AR), as a compromise. It creates state run health care programs available only to welfare recipients. Initially, the AMA argues that this is a "slippery slope" to socialized medicine; but they were persuaded to drop their opposition and accept Kerr-Mills as a compromise position. Without significant AMA opposition, the bill passes in September 1960. It is the basis of modern Medicaid. But by 1963 there were still 18 states that had not implemented Kerr-Mills.
1961: President Kennedy backs a bill introduced in the Senate by Clinton Anderson (D-NM) and in the House by Representative Cecil King (D-CA). King-Anderson is a renewed Medicare bill. The Prsident's backing panics the AMA, which thought it had negotiated Medicare off the table by accepting Kerr-Mills. The AMA launches a sophisticated lobbying campaign, known as "Operation Hometown." It organizes local medical societies to give speeches, publish articles, and provide High School debate preparation, all pushing the theme of "socialized medicine." In addition, they organize "Operation Coffee Cup," in which women hold coffee klatsches to play an 11-minute recording by Ronald Reagan titled, "Ronald Reagan speaks out against Socialized Medicine." The Reagan recording is an impassioned plea to write letters to Congress to defeat Medicare. King-Anderson fails to pass in the Senate by four votes.
1962: President Kennedy makes Medicare the key issue of the 1962 mid-term elections. In May, he addresses a crowd of 20,000 in Madison Square Garden on the necessity of enacting the bill.
1963: The Medicare bill again fails to pass the Senate, this time by just two votes.
1964: President Lyndon Johnson makes Medicare passage a crusade, asking the Congress to pass it as a tribute to President Kennedy. He argued that the Medicare bill is part of the dead President's legacy. Throughout 1964, the Administration suffers a series of setbacks, culminating in a debacle when a deadlocked Conference between the two houses adjourns, thereby killing Medicare for 1964 (and Social Security COLA as well).
July 1965: Congress enacts Medicare.
1993: President Clinton creates a Task Force, headed by the First Lady, to create a health care reform bill. President Clinton had campaigned heavily on the issue in 1992. The goal of the Task Force is to create a comprehensive plan for universal health care coverage. The plan is presented to Congress in September 1993. It is opposed strongly by the AMA, health insurers, and hospital associations.
September 1994: Senate Majority Leader George Mitchell declares the health care reform bill dead.
There is much to be learned from this history. Included in the lessons, I think, are:
- We are standing on the backs of visionary giants.
- Every incremental success was the result of compromise.
- Every previous step has taken years to enact.
- Insufficient political skills led to Senate defeat on at least four occasions (1961, 1963, 1964 and 1994). Failure to get just two votes (1963) or four votes (1961) led to years of setback. Failure of a Democratic House and Democratic Senate to reach a compromise led to months of setback (1964)
We have come a remarkable way in seven months. In light of the history, "remarkable" may be too mild a term.