October 18, 1993, Monday, CITY EDITION ; VIEWPOINTS; Pg. 41
By Al Gordon. Al Gordon is a Viewpoints editor.
IT IS SAID that the best is the
enemy of the good, and the history of national health insurance would seem to
prove the point.
Now that President Bill Clinton
has put the issue back on the national agenda, we would do well to recall what
happened the last time Washington seriously tackled the health issue - 20 years
ago.
A 1975 staff report from the House
Ways and Means Committee disclosed the then-shocking statistic that health-care
expenditures in the United States had climbed to $ 104.2 billion in 1974 from $
25.9 billion in 1960, with the share of the Gross National Product going to
health spending soaring to 7.7 percent from 5.2 percent.
The experts warned that, if
nothing was done, things would only get worse. Nothing was, and they did. Today,
health-care costs exceed $ 800 billion and consume more than 14 percent of the
GNP. The first major moves toward
national health insurance in the United States date back to the ‘40s, when
some liberals regarded it as a logical extension of the New Deal. President
Harry S. Truman made it a key plank of his political platform. But his
initiative never went anywhere.
A decade and a half later,
President John F. Kennedy advocated health-care coverage for the elderly, but
was battered by opposition from the American Medical Association, the insurance
industry and most of Big Business for advocating “socialized medicine.” It
wasn’t until 1965 that President Lyndon B. Johnson could find the votes in
Congress to pass Medicare, and also to restructure federal medical assistance to
the poor as Medicaid.
In the late ‘60s, Sen. Edward M.
Kennedy (D-Mass.), backed by organized labor, took on comprehensive national
health insurance as his cause. He sought to create a single federal program that
would replace the existing patchwork system of public and private plans.
During the 1971-72 congressional
session, President Richard M. Nixon endorsed a program of “catastrophic”
health coverage. Rejecting Kennedy’s plan, Nixon called instead for sheltering
Americans against crushing health bills. He proposed a mixture of existing and
new plans, and a bigger role for the states.
To read the yellowing committee
reports describing the various bills today is to be struck by the fact that the
differences were not so important as the overall agreement to make a major
change in the way Americans financed their health care.
Still, the two sides failed to
reach a compromise on federal authority over health care.
It is hard to believe that, if the Nixon proposal had become law,
Congress would have resisted the temptation to sweeten it during the last 20
years.
Clinton clearly has been
influenced by the historical record. He has declined to propose the single-payer
federal health-insurance plan favored by many Democratic constituencies, seeking
instead a plan with broader support. In particular, Clinton makes less of a
frontal assault on the health and insurance industries than prior Democratic
efforts.
This year is very different from
1972. Neither organized labor nor
Big Business has the clout today that it had 20 years ago, and many elements of
the business community now see national health insurance as essential to their
economic competitiveness. The health-care and insurance industries are a little
less hostile. There is an apparent
public consensus that, as the president put it in his speech to Congress, “Our
health care system is badly broken, and it’s time to fix it.”
But we should not forget it took
50 years to get to this point. The question that should be asked is not whether
the Clinton plan is perfect, but whether it is better than another 20 or more
years of delay.
Copyright 1993, Newsday Inc.