Thursday, October 31, 2013
Health Reform Has a History of Failure
Health care reform is on everyone's mind. It's an idea, they say, whose time has come. The cost of health insurance is out of control. 40 plus million Americans cannot afford or cannot qualify for health insurance.But health care reform has been here before. Actually, about every 15 years there is a push for reforming health care in America. It started way back in 1912 when Theodore Roosevelt's Bull Moose Party introduced a platform calling for national health insurance for industry.In 1934 as part of the New Deal, Franklin Roosevelt considered proposing universal health coverage as part of the Social Security Act. Presidents as diverse as Truman, Carter, Ford, George H.W. Bush and Clinton have all introduced various proposals for health care reform. Universal health coverage is always the stated goal. All the proposals put forth by all these administrations, dating back to the early 1900's have only thing in common-failure.In 1943 President Truman proposed a single insurance plan that would cover all Americans. His plan allowed for public subsidies for the poor. This universal, comprehensive plan was to be run as part of Social Security. But Truman was faced with an economy that was transitioning from a war time economy to a peace time economy. For a time Truman lost the confidence of the general public. Republicans gained control of both houses of Congress in 1946 and branded Truman as a lame duck. But Truman campaigned in 1948 on a promise to extend the New Deal and specifically targeted Congressional Republicans who has opposed national health insurance. Truman defeated these Republicans and seemed to have a mandate from the people to implement national health insurance. But despite having a Congress that had a Democratic majority, Truman could not pass his health reform plan. His plan failed because powerful Southern Democrats, all of whom held key leadership positions in Congress, feared that federal involvement in health care would lead to desegregation of hospitals that still separated patients by race.Labor unions also played a part in the defeat of Truman's plan. The AFL-CIO supported the plan for universal coverage as did the UAW. But then, the UAW negotiated a deal with General Motors that included payment by GM of health insurance and pensions. Unions then believed that they could negotiate better benefits for their members than they could get under a federal universal health plan and they abandoned their support of universal care. The AMA also opposed the Truman plan but they based their opposition on the unpopular concept of socialized medicine. As anti-communist sentiment rose, the public support for universal health care declined. Most large associations including the Chamber of Commerce, the ABA and the American Hospital Association supported the concept of voluntary and private health insurance. This was also the position favored by most of the nation's media.Universal health insurance failed again in 1950. By that time the employer sponsored plans were deeply entrenched as an employee benefit. This was the time that insurance companies began to experience rate premiums. The result of this new rating system was that older, sicker people found it harder to get affordable coverage. In 1960 Congress passed the Kerr-Mills Act. This Act provided federal funds to the states to cover the health costs of the elderly who were too poor to afford health insurance. But this Act, with all its well meaning hope, failed completely because by 1963, only 28 states had agreed to participate and even those states did not budget correctly to support the plan. This Act became the precursor to Medicare and Medicaid.From 1970 through 1976 more competing plans were proposed But compromises came and went and no significant bill ever reached the House floor because of lack of Committee consensus. President Ford withdrew his attempt at universal health reform fearing that it would make inflation worse. President Carter campaigned on the promise of a comprehensive national health plan but once elected shifted his priorities to cost containment, specifically hospital cost control, and told the American people that national health insurance would have to wait until the economy was stronger.About that time, Senator Edward Kennedy introduced a new proposal which called for private health insurance companies to compete for customers. The private plans would sell an insurance card to be used for hospital and physician care. The cost of the card would depend on income and employers would be expected to cover the majority of the cost for their employees. The federal government would pick up the cost of the card for the poor. Neither the Carter nor the Kennedy proposal made it through the Congress.The Clinton plan also supported universal health insurance through the enforcement of individual and employer mandates. The government would control the competition between private insurance companies The Health Care Task Force, chaired by Hillary Clinton when she was first lady, gave President Clinton a complex plan in September 1993. Despite a Democratic Congress, the size and complexity of the plan slowed its progress through Congress and lost the interest of the general population.Now in 2009, another administration is proposing health care reform. The White House has created the Office on Health Care Reform. Members of Congress are polishing up their own creations for solving this problem. The administration believes that popular opinion will compel our elected officials to end what might be considered a national embarrassment of having millions of American unable to afford or have access to quality health insurance. But as far back as the 1930's, public support quickly began to fail as the insured were advised that the goal would only be achieved if they contributed more to the cost, either directly or through some added taxes.The United States spends twice as much per capita as the average of the 10 next richest countries in the world. Yet, despite this expenditure, 1 out of 6 Americans under the age of 65 are uninsured and/or individually uninsurable.One of the problems facing reform is that the 80% or so of American who have health insurance are generally happy with the care they receive. They like their doctors and the freedom to make their own choices when it comes to doctors and hospitals. Most think they already pay too much for health insurance. Most believe, and there is evidence to support this belief, that the red tape and the administrative expenses of their health insurance plan are part of the reason their cost has increased. Why can't someone fix that, they wonder?The insured fear change. Any proposal that threatens their current insurance arrangement will be regarded with deep suspicion. Everyone is aware of the power of special interest groups. Our political system is set up in such a way as to frustrate action on any large and socially controversial idea. Congressional committees wield enormous power. The interest of each state in controlling its own health insurance programs can, in itself, bring down the whole idea of reform.We have had some success in improving access to health care for million through some of the Children's Health Insurance Programs. But note that most of the programs to cover uninsured children are state based.We seem to be unable to learn from past mistakes or take advantage of the concepts that actually have worked. Anyone who has done even a cursory study of history should realize that we have been here before.Yes health reform is back again. What will happen this time? Stay tuned.