The Insane Buildup to Medicare and Medicaid

In today's highly publicized debate around the notion of universal healthcare in America, one could think that it is a relatively new idea. Sure, Great Britain's NHS and Japan’s Social Health Insurance have been around for decades, but in the hyperindividualistic United States, "Socialized Medicine" can't have been a historically popular idea, can it? In 2020, the Pew Research Center randomly selected 11,001 Americans and found that 63% of them felt it was the responsibility of the federal government to make sure that all U.S. citizens have healthcare coverage (up 4% from the previous year)[1]. This begs the question, if so many Americans want a national health plan, why don’t we have one? What does the history of Medicare in the United States tell us about the idea of universal insurance as a whole, and more importantly, why did it take so long to establish this kind of system? If the definition of insanity is doing the same thing over and over while expecting different results, then the buildup to Medicare and Medicaid truly was insane.


The first main involvement that the federal government had in national medical care occurred immediately after the Civil War with the construction of 40 new hospitals in the recently defeated South [2]. For the years that followed, health insurance as a concept was relatively niche. But as the Progressive Era began and the second Industrial Revolution took over the United States, the need for some kind of health-related worker protection became more apparent. In 1912, a man named John B. Andrews and his colleagues at the American Association for Labor Legislation (AALL) began to campaign for health insurance. According to a study by I.S. Falk, “Health insurance, patterned largely on British National Health Insurance of 1911, was to provide corresponding protection against non-work-related risks, services, and costs” [3]. This campaign ultimately failed during the years of World War I as the American Medical Association (AMA), business groups, insurance companies, and labor organizations retracted their original support for the legislation.


As the Great Depression raged in the 1930s, President Franklin Delano Roosevelt (FDR) completely overhauled the United States’ welfare system through the use of an electoral mandate labeled the “New Deal.” Many saw this as an opportune time to establish and implement a national health program. An arrangement was therefore made in the Social Securities Act of 1935 to create such a system. But after pushback from lobbyists and insurance companies, the plan was ultimately removed over fear that the bill wouldn’t pass at all if it were to be introduced with the provision included [3].


The Great Depression was almost immediately followed by World War II, lasting from 1939-1945. After the passing of FDR in 1945, his second in command, Harry Truman, rose to the Presidency. That same year, Truman introduced a comprehensive medical insurance plan that would guarantee coverage for all Americans. According to a study done by Sandra Carr Hayes, “This bill called for national health insurance that would be subsidized by a federal payroll tax” [4].


It was also during this time that anti-communist sentiment began to rise exponentially in the United States due to the post-war conflict with the USSR.


Anti-communists in Congress quickly took hold of Truman’s proposal and labeled it as “Socialized Medicine” despite his insistence to the contrary. (Interestingly enough, single payer healthcare systems were being implemented in democracies across Europe after the war. But frequently, this was done by the anti-communist parties. Britain’s NHS, for example, was brought into existence by Conservative Party Prime Minister, Winston Churchill, not by the more left leaning Labour Party [5]). Ultimately, the bill never passed, facing opposition from nearly every sector it would impact. So instead of a universal, compulsory system for all, America would have a public welfare state for the very poor, and private sector health insurance for those who could afford it.


But then came the 1960s. Lyndon B. Johnson’s landslide victory in the 1964 Presidential election gave him an electoral mandate to implement his “Great Society” policies. After the introduction of a piece of elder care legislation in 1958 which focused on covering hospital costs for the aged, the debate around universal health insurance began to change. What if it were possible to insure certain segments of the population in policy intervals, rather than apply a large system overhaul with broad stroke legislation? Despite the lack of the AMA’s endorsement, this policy was ultimately taken up by Congress to address care needs for older Americans and was passed with bipartisan support. So, after years of deliberation, on July 30th 1965, Medicare and Medicaid were signed into law. One plan (Medicare) would provide universal healthcare for the elderly, while the other (Medicaid) would be used by the very poor.


The leadup to Medicare’s implementation was a long and arduous process, and in that process, a pattern emerged. Policy recommendations would be added into proposals, major associations and sectors would oppose those recommendations, and the plans to create a national healthcare system would be scrapped. But ultimately, that insane buildup was worth it. Even though the United States still lacks a universal healthcare system, Medicare and Medicaid remain popular. According to a 2015 poll conducted by the Kaiser Family Foundation, 77% of Americans view Medicare as an important government program [6]. Showing that sometimes, even insanity can yield good results.


References


1. Jones, B. (n.d.). Increasing share of Americans favor a single government program to provide health care coverage. Pew Research Center. Retrieved March 16, 2022, from https://www.pewresearch.org/facttank/2020/09/29/increasing-share-of-americans-favor-a-singlegovernment-program-to-provide-health-care-coverage/


2. Manchikanti, L., Helm Ii, S., Benyamin, R. M., & Hirsch, J. A. (2017). Evolution of US Health Care Reform. Pain Physician, 20(3), 107–110.


3. Rothman, D. J. (1993). A Century of Failure: Health Care Reform in America. Journal of Health Politics, Policy and Law, 18(2), 271–286. https://doi.org/10.1215/03616878-18-2-271


4. Hayes, S. (2004). Universal Healthcare in America. Journal of Health Ethics, 1(1). https://doi.org/10.18785/ojhe.0101.05


5. Toward a National Medical Care System: II. The Historical Background. (1986). Journal of Public Health Policy, 7(3), 291–295. https://doi.org/10.2307/3342456


6. Norton, M., DiJulio, B., & 2015. (2015, July 17). Medicare And Medicaid At 50. KFF. https://www.kff.org/medicaid/poll-finding/medicare-and-medicaidat-50/

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