by Alan F. Zundel
(Originally posted September 15, 2017)
National health insurance was first instituted in Germany in 1883 by chancellor Otto von Bismarck. Who was Bismarck? An arch-conservative trying to win worker support away from the growing socialist movement, which he suppressed with the Anti-Socialist Laws of 1878.
Far from being an idea nurtured solely by socialists or the “far left,” national health insurance has long been a proposal within the mainstream of modern politics.
In the United States the idea was first taken up by Teddy Roosevelt, who switched from the Republican to the Progressive Party in his Presidential campaign of 1912. (He lost in a three-way race to Democrat Woodrow Wilson.)
Opponents from business, the insurance industry, and medicine soon mobilized against the idea and tagged it first as foreign German idea (our enemy in World War I) and then after the Russian Revolution a communist one.
FDR & Truman
Yet President Franklin D. Roosevelt picked it up in the 1930s for his New Deal program to address the Great Depression. He had his Committee of Economic Security develop a secret report for a system of national health care, but he held back from proposing it until he passed the Social Security Act of 1935.
FDR then had the Social Security Board then do further work on the plan and presented it at a major conference in July 1938. He sent the plan to Congress in January 1939 but his attention was diverted to World War II. He revived the issue in his 1943 State of the Union address, calling for a “cradle to grave” social insurance system, and in 1944 campaigned for an economic bill of rights that included universal health care. FDR supported national health insurance again in his 1945 State of the Union address but unfortunately died that April.
Where Roosevelt was cautious, his successor Harry Truman was bold. Truman backed the Wager-Murray-Dingell bill for universal health care and took on the conservative opposition. After winning an unexpected election victory in 1948, he submitted a plan for national health insurance but it was stalled by the rise of anti-communist McCarthyism. The Democrats then turned to a step-by-step strategy.
Medicare & Medicaid
Bills to establish national health insurance for seniors were introduced in 1959, 1960, 1961, and 1962, throughout the terms of Presidents Dwight Eisenhower and John Kennedy, but got stuck in the House Ways and Means Committee. The chair, Arkansas Democrat Wilbur Mills, was concerned that national health insurance would force southern hospitals to treat black patients and so refused to hold hearings on the bills.
Kennedy worked on Mills and was able to get hearings in 1963, but was assassinated that November. His successor Lyndon Johnson next took up the cause and after a landslide election in 1964 passed Medicare and Medicaid, landmark programs providing government health insurance to seniors, the poor and the disabled.
But this was not the end goal. After the assassination of Bobby Kennedy in the Presidential campaign of 1968, his brother Senator Ted Kennedy took up the unfinished task of universal health insurance during the Nixon Presidency.
Nixon, worried about a Presidential bid from Kennedy in 1972, developed his own plan for national health insurance, relying on mandating employers to offer health insurance and subsidized insurance for poor families. However, when he unveiled it early 1971 it proved to be too liberal for conservatives and too conservative for liberals, who stuck with Kennedy’s plan for single-payer health insurance.
During Nixon’s second term he again wanted to get in front of the issue and instructed his staff to consider all options, even single payer. They came up with the “Comprehensive Health Insurance Program,” which was similar to his previous plan but more extensive. It provided for an employer mandate, a comprehensive benefit package, and government subsidies for those without government or employer insurance.
(Nixon’s plan was essentially the template for Governor Mitt Romney’s health care plan in Massachusetts in 2006 and President Barack Obama’s Affordable Care Act in 2010.)
Nixon even entered into secret negotiations with Kennedy and Wilbur Mills for a compromise plan, but with the Watergate issue heating up Kennedy and Mills decided to go forward with a bill of their own, a single-payer plan with cost-sharing by consumers and an intermediary role for employers. When the Watergate scandal forced Nixon from office his successor Gerald Ford worked with Mills on a bill until Mills was caught up in a scandal himself.
Ford lost the election of 1976 to Jimmy Carter, a conservative Democrat more concerned with controlling health care costs than extending coverage. When he repeatedly rebuffed Kennedy’s overtures to support single-payer, Kennedy challenged him for the 1980 Presidential nomination.
Clinton & Obama
Republican Ronald Reagan won that election and initiated the conservatism of the Reagan-Bush years of the 1980s, during which there was an ill-fated catastrophic coverage bill which passed but almost immediately repealed. Bill Clinton took up the gauntlet when he finally recaptured the Presidency for the Democrats in 1993. However Clinton rejected single-payer for a “managed competition” approach which spectacularly failed to pass Congress.
Senator Kennedy, frustrated with Clinton and working around him, managed to pass a successful bill in 1997 to extend health insurance to children just above the poverty line by funding it with a tax on tobacco. The State Children’s Health Insurance Program (SCHIP) was the biggest expansion of government health insurance since Medicare and Medicaid. Six years later Kennedy worked with the George W. Bush administration to extend prescription drug coverage to Medicare patients, although he bitterly opposed the final form of the resulting bill.
After gaining a commitment from Barack Obama to make universal health coverage a top priority of his administration, Kennedy endorsed him over Hillary Clinton for the 2008 Presidential nomination campaign. Kennedy continued to engage in the health care negotiations leading up to Obama’s Affordable Care Act of 2010, although he died of brain cancer before it passed.
“Medicare for All”
Now it is Senator Bernie Sanders, a longtime proponent of single-payer, who has become the leading figure to bring single-payer health insurance to the United States. Sanders’ continued popularity after his Presidential run and widespread dissatisfaction with the complexity of the ACA have brightened the prospects for a “Medicare For All” bill, which has its opponents panicked.
Is single-payer national health insurance a far-left proposal from the fringe of politics, as they claim? Only someone ignorant of American history could think so.