“Obama Care” – Part 2, The History

On February 6, 1974, President Richard M. Nixon proposed a comprehensive health insurance plan to Congress.

How the times they have changed! Following is the first sentence of President Nixon ‘s address:

One of the most cherished goals of our democracy is to assure every American an equal opportunity to lead a full and productive life.
In the last quarter century, we have made remarkable progress toward that goal, opening the doors to millions of our fellow countrymen who were seeking equal opportunities in education, jobs and voting.

Now it is time that we move forward again in still another critical area: health care.

Without adequate health care, no one can make full use of his or her talents and opportunities. It is thus just as important that economic, racial and social barriers not stand in the way of good health care as it is to eliminate those barriers to a good education and a good job.

It is hard to believe that nearly 40 years ago, it was a Republican President speaking like this.

I will continue to quote President Nixon because he says it all:

Three years ago, I proposed a major health insurance program to the Congress, seeking to guarantee adequate financing of health care on a nationwide basis. That proposal generated widespread discussion and useful debate. But no legislation reached my desk.

Today the need is even more pressing because of the higher costs of medical care. Efforts to control medical costs under the New Economic Policy have been Inept with encouraging success, sharply reducing the rate of inflation for health care. Nevertheless, the overall cost of health care has still risen by more than 20 percent in the last two and one-half years, so that more and more Americans face staggering bills when they receive medical help today:

–Across the Nation, the average cost of a day of hospital care now exceeds $110.  {!!!]
–The average cost of delivering a baby and providing postnatal care approaches $1,000.
–The average cost of health care for terminal cancer now exceeds $20,000.

For the average family, it is clear that without adequate insurance, even normal care can be a financial burden while a catastrophic illness can mean catastrophic debt.

Beyond the question of the prices of health care, our present system of health care insurance suffers from two major flaws :

First, even though more Americans carry health insurance than ever before, the 25 million Americans who remain uninsured often need it the most and are most unlikely to obtain it. They include many who work in seasonal or transient occupations, high-risk cases, and those who are ineligible for Medicaid despite low incomes.

Second, those Americans who do carry health insurance often lack coverage which is balanced, comprehensive and fully protective:

President Nixon then shares how his health care plan would be organized:

The plan is organized around seven principles:

First, it offers every American an opportunity to obtain a balanced, comprehensive range of health insurance benefits;
Second, it will cost no American more than he can afford to pay;
Third, it builds on the strength and diversity of our existing public and private systems of health financing and harmonizes them into an overall system;
Fourth, it uses public funds only where needed and requires no new Federal taxes;
Fifth, it would maintain freedom of choice by patients and ensure that doctors work for their patient, not for the Federal Government.
Sixth, it encourages more effective use of our health care resources;

And finally, it is organized so that all parties would have a direct stake in making the system work–consumer, provider, insurer, State governments and the Federal Government.

Unfortunately, President Nixon’s health care initiative never went further because of the Watergate affair.  In the end, President Nixon resigned the presidency and the question of health care once again was pushed aside. 

In his memoirs, “Seize the Moment” Nixon reiterated his views on why health care is such an important topic:

“We need to work out a system that includes a greater emphasis on preventive care, sufficient public funding for health insurance for those who cannot afford it in the private sector, competition among healthcare providers and health insurance providers to keep down the costs of both, and decoupling the cost of healthcare from the cost of adding workers to the payroll,”

Next came President Jimmy Carter, but he had alienated the Congress so badly, that he had very little sway over them and the question of health care floundered.

Under Ronald Reagan, a health care mandate  was passed.  This turned out to be a compromise that ended up taxing the wrong people, that is the hospitals, with no stipulation to be repaid for their services.

The law requires hospitals to treat patients in need of emergency care regardless of their ability to pay, citizenship or even legal status. It applies to any hospital that takes Medicare funds, which is virtually every hospital in the country.

Under President Bill Clinton, a comprehensive health care system was devised based on universal coverage.  Although the added coverage would be expensive, the cost of non-insured and the poor in emergency room procedures was more.  Hillary Clinton headed up the task force to provide the proposal.  Clinton’s plan, like Nixon’s, called for building on the existing private-sector health-care system and using government subsidies and tax credits to get all Americans under an umbrella of health coverage. Like Nixon, Clinton said her plan “is not government-run. There will be no new bureaucracy.”

In 1993, 23 Republican senators, including then-Minority Leader Robert Dole, cosponsored a bill introduced by Senator John Chafee that sought to achieve universal coverage through a mandate that is, a mandate on individuals to buy insurance. Nearly every major health care interest group had endorsed substantial reforms–grandiose ones, in fact. The American Medical Association (AMA) and Health Insurance Association of America (HIAA), the two great, historic bastions of opposition to compulsory health insurance, both went on record in support of an employer mandate and universal coverage. Even the U.S. Chamber of Commerce endorsed an employer mandate, as did many large corporations. Other groups came out variously for reform options that ran along a spectrum from Canadian-style, single-payer programs on the left to managed competition and medical savings accounts and radical changes in tax policy on the right. Under the circumstances, it was easy to believe the country was ready for substantial reform and that a market-oriented, consumer-choice approach to universal coverage, positioned in the center, could become a platform for consensus.

But, once again,  politics got in the way, and thus this health care initiative came crashing down. And every year, the health care costs have gone up.

These days, a day stay in the hospital costs at least $1,700, sometimes more, depending on which hospital.  Back to the history and onto…..

George W. Bush signed into law the Medicare Modernization Act.  This was supposed to provide all 40 million Medicare beneficiaries with a voluntary prescription drug benefit. This drug benefit gave seniors their choice of various plans to help them afford the cost of their medicines.  Of course what was not taken into account were the pages and pages of documents that these seniors were expected to go through.  And then there was the donut hole, that place wherein which the senior would fall when they reached a cap of $2,250 in their prescription drug costs.  In an environment where a pill can cost as much as $1,000, that hole could reach the senior fairly quickly.  And thus, something that looked like it was giving, ended up giving nothing.

So, the picture looks a little bit like different administrations offering a cake and being shot down for political reasons and some administrations getting crumbs through but with consequences that somehow undermine the crumbs thrown at the public.

Meanwhile, the law makers who keep negotiating and fighting against the idea of a universal health care system have the best healthcare system provided them for life.

(to be continued)

© Yvonne Behrens, M.Ed 2012

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