Health Care Reform Debate: It’s Déjà Vu Again

Health Care Reform Debate: It’s Déjà Vu Again

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Well before the “pangs” of today’s economic recession were felt, Americans had to deal with “the cruelty of a health care system that just did not work for too many citizens,” President Obama said last week in a speech defending his foremost legislative achievement, the passage of the Patient Protection and Affordable Care Act (PPACA) ten months ago. “Americans have more power, greater freedom, stronger control of their health care,” he continued, adding, “It’s no secret that not everyone in Congress agrees with this law.”

It’s not just Congress that has some problems with the new bill: A federal judge in Florida has ruled on Monday that key pieces of the new law are unconstitutional, including the “individual mandate” requiring most Americans to buy health insurance within four years or face fines.

As all of this plays out across the national stage, I’m reminded of just how long efforts to implement, reform, and repeal health care coverage in this country have been occurring.   When I was in high school back in 1947, federal involvement in the health of Americans was a debate team topic. That was the year of the third version since 1944 of the Wagner-Murray-Dingell bill, a proposal to provide Americans with universal national health insurance. It was fought by major politicized organizations – chief among them, the American Medical Association – and the fourth try at passing the bill in 1949 was defeated. 

Then came Lyndon Johnson’s Great Society, when Medicare and Medicaid sprung up as outgrowths of the Social Security Act. The AMA again opposed it, though eventually it put its own stamp on the legislation. After that came serious efforts to revamp health care during Bill Clinton’s administration but ineptness and a narrow base of consultation doomed that plan. By then, of course, there was powerful opposition from the insurance and pharmaceutical industries.

President George W. Bush declared his intention to improve health coverage during his two campaigns, but nothing came of it despite the continued efforts of Democrats, among them Senator Ted Kennedy. The goal of universal health care was at the core of their political agendas; Barack Obama of Illinois was one of those people.                                                                   

During this reiteration, the public option to enroll in a government-administered insurance plan had to be dropped. And it’s this compromise that congressional Republicans are now determined to overthrow, partly because they fear “creeping Socialism.”

Back in 1947, the final health care bill provided only for employer-employee contributions to a national care fund; it did nothing for those without jobs. Liberals thought this a major weakness and pressed for a truly universal system administered by government. Sound familiar? Those futurists wanted to go beyond the public option and implement universal government-run health insurance system. Conservatives and many middle-of-the-road Republicans protested that a government-administered plan would lead to a loss of physician autonomy.

Here’s where I stand: Not only are appeal attempts impossible to pass in the current Senate or to be signed by the President, they have a far greater weight hanging around their collective necks than the mere number of votes they can attract. That weight is the tide of responsibility increasingly expected of a progressive society. Even conservative presidents like Nixon and Bush recognized the need for universal health care; even self-interested organizations like the AMA and the rank and file of American physicians see the need. It is primarily the interests standing to suffer huge financial losses – such as the pharmaceutical and insurance industries – that remain icons of immobility, and perhaps less so with each passing year. 

There will always be plenty of self-proclaimed independent-minded individuals who resist the nature of social change (while refusing to acknowledge how they benefit). But their number will lessen, just as the number of staunch opponents of Social Security, unemployment insurance and Medicare did once their value became apparent.

Sherwin B. Nuland is Clinical Professor of Surgery and a Fellow of the Institution for Social and Policy Studies at Yale. 

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