The Presidents Who Brought Us the Closest to Universal Health Care, Part 1

In honor of President’s Day, here’s a two part run-down of the presidents who took us closest to the goal of universal health care.  I'm not including those who introduced a new benefit to an existing program, or created favorable business conditions for the private insurance industry to innovate, or proposed universal health care during the campaign but never reached the Oval Office (a tradition dating back to Theodore Roosevelt’s third-party run in 1912), but those men who proposed or actually pushed for a comprehensive set of health care benefits for every citizen in the country.  For those who might only remember the health care fights of the 1990s, you’ll soon realize just how much of this is the same old fight, destined to be repeated every few decades.

Franklin D. Roosevelt

Yes, the man who brought us the New Deal and the creation of Social Security, and guided us through World War II very nearly made health insurance for all citizens part of the social contract from the get-go.   Indeed, drafts of the legislation for the Social Security Act from 1935 included language that would have created a compulsory national health insurance, very loosely modeled on Germany’s decades-old universal health care system, but far more familiar in general structure to what single-payer advocates have proposed ever since:  government would amass a pool of insurance money based on taxes, and from that pay every citizen’s medical expenses.  What stayed FDR were political concerns – specifically that overburdening the Social Security Act would make it too difficult to pass.  Plus, with an overwhelming focus in the public’s mind on the economy, and without an immediate association between the economy and health care, it seemed better to push it off for a more welcoming political climate in the future.  (Watch for this to be a recurring pattern).

Instead, FDR created an ad hoc committee called the Interdepartmental Committee to Coordinate Health and Welfare Activities whose study of the health care issue and recommendations were intended to pave the way and create support for universal health care.  However, the committee’s report in 1938 instead gave a number of recommendations that fell just short of a mandate for universal health care, but focused primarily on federal grants to the states to develop their own programs for the disabled, the elderly and the needy.

Health care would pop up from time to time throughout FDR’s administration, and as recently as 1944 he expressed confidence that it was inevitable, but it never seemed the right time.  Moreover, any talk of reform drew furious political pressure from the American Medical Association.  Recent improvements in medicine had also made the practice of it very profitable.  Despite constant ameliorating language from the White House about the primacy of doctors in making medical decisions, the AMA was dead-set against any comprehensive national health care program.  In short, they helped make it never be the right time for health care reform.

(As a fun side note, socialized medicine wasn’t really the scare here – it was the primacy of your doctor in making medical choices, another talking point that is still with us.  Why not socialized medicine?  Well, largely because, with Germany as a model, the worst you could say was that it was fascist medicine – an equally untrue charge, and one that understandably never caught on.)

Harry S. Truman

Harry Truman had only been president 7 months when he began pushing for a revamping of the national health care system.  In an address to Congress, he declared, "The health of American children, like their education, should be recognized as a definite public responsibility."  Most of his proposals were not about coverage – they were about creating new hospitals, using federal funds to bump up the salaries of doctors and nurses and attract more people to the profession, and creating a new board to ensure standards of quality for hospitals.  However, the most controversial part – and the part that most people remember – was the fight for national health insurance.

Although Truman’s plan is still considered a “universal” health care plan, it was explicitly optional.  By this time, some private insurance options, like the not-for-profit Blue Cross Blue Shield, were widely in use and popular.  Similarly, the employer benefit system that we rely so heavily on today had sprouted up during World War II when price controls kept salaries below a certain cap and employers needed other goodies – health benefits – to competitively attract employees.  So Truman’s proposal was the first historical precursor of the Obama line, “If you like your coverage, you can keep it.”  But whoever wanted to could make a monthly payment into a national pool.  The government would pay for medical care for each participant out of the pool and, in the event of lost waged due to illness or injury, would even give a cash payout to the individual.

The AMA, which had started to throw its weight around in the 1930s, savaged Truman’s plan.  In a wide-open fee-for-service market, doctors and specialists could charge what the market would bear.  But if 1/3 or 1/2 or more were in the National Health Insurance plan, the program would be able to set standard costs and payments, and the private market would undoubtedly follow.  The AMA’s campaign brought up, for the first time, the charge of “socialized medicine,” even though no Communist country had a system like this, and went so far as to declare that the White House was staffed with “followers of the Moscow party line.”  Soon, the combination of the Korean War and fierce opposition pushed national health care to the back burner.  Truman tried again when he won reelection, but facing an oppositional Congress and continued resistance from the AMA, the plan went nowhere.

John F. Kennedy

Although most people more strongly associate Lyndon Johnson with Medicare, the idea was a central component of JFK’s 1960s campaign. Once elected, Kennedy took up the cause right out of the box, in January 1961.

Check it out:

Kennedy’s push from the bully pulpit of the White House gained momentum from sky high public opinion polls (as high as 69% in favor of Medicare in one Gallup poll) and grand public events like a massive rally and presidential address in May 1962, in front of 20,000 people in Madison Square Garden which was simultaneously broadcast to 20 million TV viewers.  Members from the Kennedy Administration held similar presentations in 45 cities across the country.  Plus, the Medicare plan made a lot of sense.  In the 1960s, even with Social Security, the elderly were overwhelmingly poor, with little or no resources for medical care precisely at the age when they needed the most care.  Medicare classically followed the Social Security model of current workers subsidizing retired workers, and being subsidized themselves when it came time for them to retire – indeed, Medicare would be an attachment to the Social Security Act.  The shame of an older generation left to suffer because they could no longer work and achieve health benefits from their employer was shame that had no cause to exist.

But private insurers, understandably, resisted the plan.  A national benefit for all citizens above 65 meant no customers for them over 65, not to mention a competing model for their business practices.  The AMA again rushed to the ramparts, bringing back their taunts of socialized medicine.  Two days after JFK’s speech in Madison Square Garden, the president of the AMA also delivered an address rebutting the president’s proposal – and this one was watched by 30 million viewers.  Although there was support in the House, there was insufficient support in the Senate, where the cloture vote to cut off debate failed, 52-48.

JFK moved on to other priorities and never got back to Medicare.  But his months of campaigning laid the groundwork for what was to be Lyndon Johnson’s crowning success just three years later.

Next in part 2:  Johnson, Nixon (you read that right), Clinton and Obama try their hands at reforming health care.