March 27, 2012
BOSTON — Early last century, health care entered the modern era and started the long debate on national health care policy. The American Medical Association became a powerful national voice. Surgery was becoming more commonplace and the leading industry of the day, railroads, were among the first to develop extensive employee medical programs.
Between 1910 and 1920, progressive reformers argued that health insurance should be provided to all Americans. In the '30s, the Roosevelt administration passed the Social Security Act. There was a push to include health insurance as part of the legislation but political realities prevented it.
In the 1940s, prepaid group health care began in earnest — and was seen by many as radical. During World War II, wage and price controls were placed on American employees. This led companies to compete for workers by offering health benefits instead.
After the war, President Harry Truman offered a plan for national health care, proposing a single system that would include everyone with basic care. Truman's plan was denounced by the AMA — and some called it "communist." In the 1950s, many legislative proposals were made to address hospital insurance but none succeeded. And by the 1960s the cost of hospital care had doubled over the previous decade. In 1965, President Lyndon B. Johnson signed into law Medicare and Medicaid, assisting the elderly, the disabled and low-income Americans.
By the '70s, Richard Nixon was president — and here is what this Republican proposed for 1974:
"The time is at hand this year to bring comprehensive, high-quality health care within the reach of every American." He proposed a program that would ensure health insurance coverage.
Nixon's plan was rejected, primarily by liberals and labor unions, who thought it didn't go far enough.
During the 1980s, under President Ronald Reagan, complaints continued to rise over the delivery and the costs of health care. In the early months of President Bill Clinton's term, health care costs had risen at double the rate of inflation.
The Clinton administration introduced federal health care legislation that thrust the issue into the national dialogue but quickly became a proxy for political ideology,
In the new century, health care costs continued to soar and changing demographics only exacerbated the impact. Here in Massachusetts, under Republican Gov. Mitt Romney, a state health care law was passed with support from a strongly Democratic legislature.
At the signing, Romney said, "I want to thank the many, many people in this room who were critical to crafting and coaxing the bold health care initiative I'm about to sign," including Democratic Sen. Ted Kennedy.
When Barack Obama was elected president in 2008, among his first legislative efforts was the very heated campaign for and eventual passage of the Affordable Care Act, closely modeled after the Massachusetts plan.
"Long after the debate fades away and the prognostication fades away and the dust settles, what will remain standing … [is] a system that works better for the American people," he said.
As we sit here today, the Supreme Court is considering that plan, primarily for the constitutionality of the individual mandate the act requires. And the political winds continue to blow after more than a century, leading to an awkward distancing of author to work, from Nixon to Clinton, from Obama to Romney and even from Romney to himself.
"Our plan in Massachusetts has some good parts, some bad parts," Romney said on the campaign trail. "It's different than Obamacare. Obamacare intends to put someone between you and your physician. It must be repealed."
WGBH NEWS FOCUS: HEALTH CARE ON TRIAL