US Health Care History

The US has been trying to get health care of some type since 1854 when President Franklin Pierce vetoed a bill saying he believed social welfare was the responsibility of the states. Although European countries were passing social welfare acts and forming the basis for compulsory government-run or voluntary subsidized health care programs (United Kingdom passed the National Insurance Act of 1911), the US held to federal non-participation in social welfare (1912 Teddy Roosevelt, 1935 Franklin D. Roosevelt and in 1949 Harry Truman all tried and failed in getting universal health care). In the Civil Rights era of the 1960s and early 1970s, the predominant public opinion was toward the problem of the uninsured and supported universal coverage. Supporters of health care reform were able to avoid the worst fears of "socialized medicine" (considered a dirty word for its association with communism) and President Lyndon Johnson got Medicare and Medicaid passed on July 30, 1965. In 1968 a National Opinion Research Center poll reported that 87% of Americans believed that health care was a right of all American citizens. In 1972 two economists evaluated all the proposals in Congress and said "Universal coverage of the resident population … is justified … access to medical care is a necessity, not a luxury, and that universal protection is required. Universality cannot be achieved by voluntarism, even when supported by incentives. Publicly imposed means tests are destructive … and … almost always lead to a double standard and a 'two-class' quality of care. One of the objectives of a national system must be to end such discrimination." On February 6, 1974 President Richard Nixon introduced the Comprehensive Health Insurance Act; it would have mandated employers to purchase health insurance for their employees and provided a federal health plan similar to Medicaid that any American could join by paying on a sliding scale based on income. The New York Daily News wrote that Ted Kennedy rejected the Nixon plan because it wasn't everything he wanted (the Kennedy-Mills bill of 1974 was dropped because of Mill’s sex scandal) and he later realized it was a missed opportunity to make major progress toward his goal. By the late 1970s, with concern over rapidly rising health care costs, the idea of universal coverage had fallen flat and President Jimmy Carter’s plan failed. In 1985 President Ronald Reagan signed the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) which amended the Employee Retirement Income Security Act of 1974 to give some employees the ability to continue health insurance coverage after leaving employment. In 1994 President Bill Clinton tried to compromise on the Nixon-Kennedy differences but his plan failed. However in 1997 Clinton did get the State Children's Health Insurance Program passed to provide health insurance to children in families at or below 200% of the federal poverty line. Due to intense opposition from groups including the American Medical Association and pharmaceutical industry President George W. Bush was unable to pass the Patients’ Bill of Rights (would’ve provide emergency care to anyone regardless of health insurance status as well as the right of a patient to hold their health plan accountable for any and all harm); it failed Congress in 2002. Bush did sign the Medicare Prescription Drug, Improvement, and Modernization Act which included a prescription drug plan for the elderly and disabled Americans. In 2004 Bush proposed expanding health care coverage. In January 2007 the House introduced HR 676 - The US National Health Care Act and the Senate introduced the Healthy Americans Act (S. 334) and both failed. During the 2008 campaign John McCain and Barack Obama both offered health care proposals; the McCain plan was described as to make insurance more affordable while the Obama plan was for more people to have health insurance. A poll released in early November, 2008 found that voters supporting Obama listed health care as their second priority; voters supporting McCain listed it fourth, tied with the war in Iraq; affordability was the primary health care priority among the voters. In December 2008 the Institute for America's Future together with the chairman of the Ways and Means Health Subcommittee launched a proposal from the co-director of the U.C. Berkeley School of Law Center on Health that said the government should offer a public health insurance plan to compete on a level playing field with private insurance plans; it concluded that the public plans had success at managing cost control (Medicare spending rose 4.6% compared to 7.3% for private health insurance on a like-for-like basis in the 10 years from 1997–2006); public insurance has better payment and quality-improvement methods based on its large databases, new payment approaches and care-coordination strategies; and a standard would be set against which private plans must compete which would help unite the public around the principle of broadly shared risk while building greater confidence in government over the long term. This proposal was said to be the basis of the Obama plan.

In a June 2009 NBC News/Wall Street Journal survey 76% said it was either "extremely" or "quite" important to "give people a choice of…a public…and a private plan for their health insurance.” A NY Times economist editorial said "The fundamental fact is that we can afford universal health insurance--even those high estimates were less than the $1.8 trillion cost of the Bush tax cuts." The Supreme Court on June 28, 2012 ruled that people who do not purchase health insurance can be taxed at a different rate; their 5 to 4 decision affects the 2014 portion of the bill (to be addressed tomorrow). Since 2009 the Tea Party has fought against health care reform and Republicans vow to continue to try and stop the 150+ year fight that can be paid for by discontinuing the tax cuts for the rich.