There is No Public Option without a Beginning

There have been six times in the past to deliver major legislation restructuring of the provision of hospital and medical services: 1913- 17, 1937-39, 1943-46, 1964-65, 1969-75 and 1993-94.  Each previous attempt collapsed usually generating a series of legislation crafted to assuage the legislators who fought so hard ultimately to achieve so little (Danielson and Mazer 161).  In 2009, after nearly 100 years, Democrats with Nancy Pelosi in the lead, took that ball and finally passed legislation that would guarantee access to health care. The rest is history, but it did not come without a fight. No doubt, every time the efforts failed, more policy was developed and negotiated for the inevitable, because it was inevitable that some form of Universal Coverage would pass Congress and be signed by a President from the Democratic Party.  To be perfectly honest, there was no public option in the policy that was eventually developed and finally passed through congress some parts have already been implemented and other parts are waiting for funding in this fiscal year.  Although I had been somewhat involved in Comprehensive Health Care Policy research at our local committee level for this blog I thought some extra research would be in order. I ran across an interesting excerpt of a column originally published in the Washington Post by Don Coburn one of their staff writers.  I found the excerpt in the British Medical Journal Summer, 1986, and lo and behold, I found a copy of this on-line at the National Institute of Health.  

                This is the first universal health insurance plan in the United States, and Governor Dukakis hails it as a model for the whole country. "Forty years after Harry Truman first proposed it we are finally on the road to basic health security for the citizens of this state," he said. "It's something which is long overdue for Massachusetts and long overdue for the country.'

However, the real issue before us is in understanding how we got to today, and taking some personal responsibility for the failures of the past, and some joy in the huge accomplishment of 2009. Because, in all honesty, we should have some pride in finally being able to move on from those who continue to say this will destroy us, to defending the bill, and keeping Republicans from further demonizing what is a huge accomplishments by Democrats in office. My particular thanks to Nancy Pelosi and her deft handling of her caucuses to get this bill passed. She ultimately will go down in history as one of the greatest speakers of all time. There is an excellent interactive time line of the history of Health Reform in America at the NY Times.

• 1912 - Teddy Roosevelt campaigns on a National Health Insurance policy,  Great Britain passed such a policy in 1911, and many European nations had such policies, the earliest being Germany they passed a national health insurance policy in 1883. The debate in America went on until 1917.
• 1937 –  38 The New Deal omitted plans for a national health insurance program in 1934, although it was included in the original discussion and planning for implementing New Deal Programs.  What happened in 1934? By 1938 it began to push a National Health Insurance Program. Again, it failed. There were many forces against this new plan, but in the forefront were doctors who opposed national health insurance.
• 1948 – Harry Truman includes a national health insurance program in the platform of his election campaign and it stays in the Democrat Party platform. Back then the AMA opposed a national insurance program, and claimed we were heading towards socialized medicine, the same tired argument employed by conservatives today. Essentially this is where the hard fight began. 

Well the fight began there and continued on to today.  Some states like Massachusetts, Hawaii, and Minnesota began to implement plans of their own.   In 1985 Massachusetts passed a state wide referendum, but it didn’t include what people today call “the public option” but it was a way to deliver insurance to those that had no access to insurance, therefore no access to health care other than emergency room care.  At that time, there already were an estimated 35 million people in the nation without access to health care, most of those the poor and the working poor. There were no mandates that business offer health insurance to their employees and if businesses did, the cost was often too high for someone making minimum wage. Nevertheless, by this time, the Democratic Party recognized the importance of expanding the ideals of a system that would include everyone. In 1993-94 many of us saw the fight take place and the propaganda that was used one more time to stop any move toward Universal Health, socialism… government takeover of health care, the rationing of health care, etc. One more time the propaganda scared enough people to stop Health Reform in its tracks. Remember what they called it back then, yeah Hillary Care. Sound familiar. It was beyond shocking for some of us in the trenches.  Most of us, who participated in our local policy meetings on Health Reform, were to figure out a policy that would be palatable even to Republicans. What did we think would be palatable to Republicans, well expanding FEHBP to all of America.   Hell the system was already in place, run by competent government employees, which heavily regulates insurance that covers federal employees. FEHBP, Federal Employees Health Benefits Plan, yes, it is an insurance based program heavily regulated by the Federal Government; there are requirements as to what must be covered for individuals and their families.  And of course the Federal Employee group is the largest group purchaser of insurance.  What happened during our many meetings afterwards was how to get health reform passed that would palatable to the majority of Americans.  The idea that democrats came up with was to expand FEHBP to include all Americans in that group, and then subsidize the poor so they could buy into the system of insurance, thereby getting the first step done, as other countries had in the early part of the 20^th century.  I personally did not expect people who self-identify as liberals would do as much to sabotage this move to an eventual universal system as conservatives. This time Democrats were prepared for the nonsense that goes on with Republicans who use over the top rhetoric to scare people to get them whipped up for or against any given issue. I have always considered my side smarter. I was shocked to find it is not. So that public option the left screams about was always considered a bargaining chip for Republicans, you know, okay no public option but FEHBP for everyone with subsidies for the poor.  This health policy has been in development for 12 years. Nancy Pelosi and the Democratic leadership had it ready to go when the time was right. All the stars aligned in 2008, GW Bush had done enough damage to the reputation of Republicans to give us on opportunity before Republicans could gain their footing to get a beginning, one that had been in the making since Harry Truman. Painstaking efforts had been made to get a policy in place that no one but the most ideological forces could accept. FEHBP, who knew moderate Republican legislators would reject a program they benefitted from?  Who knew some on the left would go full-bore opposition to delivering a system to the now 45 + million people without access to health care?  I was dumbfounded and remain dumbfounded that some people on the left continue to reject a beginning, without knowing the history, and not realizing this is something that can and will be built on over the years. Who knew?  We are on the verge now, of Republicans attempting to dismantle, thereby stopping progress towards that single payer system so many folks claim to support. I would implore liberals, progressive to read extensively about our struggle to get to where we are now. Be armed to take on the opposition with knowledge. Because passing this bill was the greatest achievement since Medicare/Medicaid, a crowning glory.

I am providing two pdf from the Journal of Public Health Policy, that people should read.   And if you want access the my remaining sources listed in my bibliography they are widely available at your local library through the JSTOR database.

Bibliography

Chapman, Carleton B and John M Talmadge. "Historical and Political Background of Federal Health Care Legislation." Law and Contemporary Problems 35.2 (Spring, 1970): 334-347.

Cohen, Wilbur. "Health Insurance and Government." The Journal of Insurance 29.1 (March, 1962): 7-17.

Colburn, Don. "Universal Health Insurance in the United States?" British Medical Journal 297.6640 (July 2, 1988): 9-10.

Crane, Frederick G. "Insurance Rate Regulation: The Reasons Why." The Journal of Risk and Insurance 39.4 (Dec, 1972): 511-534.

Danielson, David A. and Arthur Mazer. "The Massachusetts Referendum for a National Health Program." Journal of Public Health Policy 7.2 (Summer, 1986): 161-173.

Derickson, Alan. "Health Security for All? Social Unionism and Universal Health Insurance 1935-1958." The Journal of American History 80.4 (March, 1994): 1333-1356.

Journal, British Medical. "Review- The Insurance Act." British Medical Journal 1.2664 (January 20, 1912): 129-130.