Harry Truman’s Healthcare Plan and Our Current Sorry State

What President Truman tried to do and where we are today, by David Oshinsky for The New York Review of Books:

“Bow your heads, folks, conservatism has hit America,” The New Republic lamented following the 1946 elections. “All the rest of the world is moving Left, America is moving Right.” Having dominated both houses of Congress throughout President Franklin Roosevelt’s three-plus terms in office (1933–1945), Democrats lost their majorities in a blowout. Some blamed it on the death of FDR, others on the emerging Soviet threat or the bumpy return to civilian life following World War II. The incoming Republican “Class of ’46” would leave a deep mark on history; its members, including California’s Richard Nixon and Wisconsin’s Joseph McCarthy, were determined to root out Reds in government and rein in the social programs of the New Deal.

One issue in particular became fodder for the Republican assault. In 1945 President Harry Truman had delivered a special message to Congress laying out a plan for national health insurance—an idea the pragmatic and immensely popular FDR had carefully skirted. As an artillery officer in World War I, Truman had been troubled by the poor health of his recruits, and as chairman of a select Senate committee to investigate the defense program during World War II, his worries had grown. More than five million draftees had been rejected as “unfit for military service,” not counting the 1.5 million discharged for medical reasons following their induction. For Truman, these numbers went beyond military preparedness; they spoke to the glaring inequities of American life. “People with low or moderate incomes do not get the same medical attention as those with high incomes,” he said. “The poor have more sickness, but they get less medical care.”

Truman proposed federal grants for hospital construction and medical research. He insisted, controversially, not only that the nation had too few doctors, but that the ones it did have were clustered in the wrong places. And he addressed the “principal reason” that forced so many Americans to forgo vital medical care: “They cannot afford to pay for it.”

The facts seemed to bear him out. Close to half the counties in the United States lacked a general hospital. Government estimates showed that about $11 million was spent annually on “new treatments and cures for disease,” as opposed to $275 million for “industrial research.” Though the nation claimed to have approximately one physician per 1,500 people, the ratio in poor and rural counties regularly dipped below one per 3,000, the so-called danger line. On average, studies showed, two thirds of the population lacked the means to meet a sustained health crisis.

The concept of government health insurance was not entirely new. A few states had toyed with instituting it, but their intent was to replace wages lost to illness or injury, not to pay the cost of medical care. Truman’s plan called for universal health insurance—unlike the Social Security Act of 1935, which excluded more than 40 percent of the nation’s labor force, mostly agricultural and domestic workers. Funded by a federal payroll tax, the plan offered full medical and dental coverage—office visits, hospitalization, tests, procedures, drugs—to all wage and salary earners and their dependents. “Needy persons and other groups” were promised equal coverage “paid for them by public agencies.”

People would be free to choose their own doctors, who in turn could participate fully, partly, or not at all in the plan. Private health insurance programs would continue to operate, with policyholders required to contribute to the federal system as well—a stipulation the president compared to a taxpayer choosing to send a child to private school. “What I am recommending is not socialized medicine,” Truman insisted. “Socialized medicine means that all doctors work as employees of government. The American people want no such system. No such system is here proposed.”

It did him no good. At the first Senate hearing on the proposal, Ohio’s Robert A. Taft, . . .  known to his admirers as “Mr. Republican,” denounced it as “the most socialistic measure that this Congress has ever had before it.” A shouting match ensued. . . . Taft retreated, but not before vowing to kill any part of the plan that reached the Senate floor.

. . .  A predictable coalition soon emerged, backed by pharmaceutical and insurance companies but directed by the American Medical Association, which levied a $25 political assessment on its members to finance the effort. At its crudest, the campaign pushed a kind of medical McCarthyism by accusing the White House of inventing ways to turn a brave, risk-taking people into a bunch of “dainty, steam-heated, rubber-tired, beauty-rested, effeminized, pampered sissies”—easy pickings for the nation’s godless cold war foe. “UN–AMERICAN SYSTEM BLUEPRINTED IN THE KREMLIN HEADQUARTERS OF THE COMMUNIST INTERNATIONALE,” read one AMA missive describing the origins of Truman’s plan.

Precious freedoms were at stake, Americans were told: when the president claimed that medical choices would remain in private hands, he was lying; federal health insurance meant government control; decisions once made by doctors and patients would become the province of faceless bureaucrats; quality would suffer and privacy would vanish. Skeptics were reminded of Lenin’s alleged remark—likely invented by an opponent of Truman’s heath plan—that socialized medicine represented “the keystone to the arch of the socialized state.”

The economist Milton Friedman once described the AMA as “perhaps the strongest trade union in the United States.” It influenced medical school curriculums, limited the number of graduates, and policed the rules for certification and practice. For the AMA, Truman’s proposal not only challenged the profession’s autonomy, it also made doctors look as if they could not be trusted to place the country’s needs above their own. As a result, the AMA ran a simultaneous campaign congratulating its members for making Americans the healthiest people in the world. The existing system worked, it claimed, because so many physicians followed the golden rule, charging patients on a sliding scale that turned almost no one away. If the patient was wealthy, the fee went up; others paid less, or nothing at all. What was better in a free society: the intrusive reach of the state or the big-hearted efforts of the medical community?

Given the stakes, the smearing of national health insurance was not unexpected. What did come as a surprise, however, was the palpable lack of support for the idea. For many Americans, the return to prosperity following World War II made Truman’s proposal seem less urgent than the sweeping initiatives that had ended the bread lines and joblessness of the Great Depression. Even the Democratic Party’s prime constituency—organized labor—showed limited interest. During the war, to compensate workers for the income lost to wage controls, Congress had passed a law that exempted health care benefits from federal taxation. Designed as a temporary measure, it proved so popular that it became a permanent part of the tax code.

Unions loved the idea of companies providing health insurance in lieu of taxable wages. It appeared to offer the average American the sort of write-off reserved for the privileged classes, and indeed it did. Current studies show that union members are far more likely to have health insurance and paid sick leave than nonunion workers in the same industry. . . .

At about the same time, popular insurance plans like Blue Cross emerged to offer cheap, prepaid hospital care . . . . In 1939 fewer than six million people carried such insurance; by 1950, that number had increased fivefold. In the years after Truman’s plan died in Congress, the government filled some of the egregious gaps in the private insurance system with expensive programs for the poor, the elderly, and others in high-risk categories, thereby cementing America’s outlier status as the world’s only advanced industrial nation without universal health care. . . .

[In the United Kingdom, the National Health Service] succeeded because the Labour Party won a landslide victory in 1945 in a country battered by war and facing a bleak economic future—precisely the opposite of the American experience. Opinion polls in the UK showed strong support for a government-run system offering universal, comprehensive, and free health care financed by general taxation. But the threat of a physicians’ strike forced Labour’s health minister, Aneurin Bevan, to scrap the idea of turning doctors into full-time government employees. . . .

The UK excels in universal coverage, simplicity of payment, and protection of low-income groups. While the NHS remains quite popular, it also is seriously underfunded: the UK ranks dead last in both health care spending per capita ($3,900) and health care spending as a percentage of gross domestic product (9.6) among the six European nations [reviewed in Ezekiel Emanuel’s book Which Country Has the World’s Best Healthcare?] The most common complaints . . .  concern staff shortages and wait times for primary care appointments, elective surgeries, and even cancer treatments . . .  “The public does not want to replace the system with an alternative,” writes Emanuel. “All the public wants is a fully operational NHS.”

By contrast, the US health care system—if one can call it that—excludes more people, provides thinner coverage, and is far less affordable. It combines socialized medicine practiced by the Department of Veterans Affairs, four-part federal Medicare (A, B, C, D) for the elderly and disabled, state-by-state Medicaid for the poor, health coverage provided by employers, and policies bought privately through an insurance agent or an Affordable Care Act exchange—all of which still leave 10 percent of the population unprotected. . . . “The United States basically has every type of health financing ever invented,” Ezekiel adds. “This is preposterous.”

And extremely expensive. America dwarfs other nations in both health care spending per capita ($10,700) and health care spending as a percentage of GDP (17.9). Hospital stays, doctor services, prescription drugs, medical devices, laboratory testing—the excesses are legion. Childbirth costs on average about $4,000 in Western Europe, where midwives are used extensively and charges are bundled together, but close to $30,000 in the US, where the patient is billed separately by specialists—radiologists, pathologists, anesthesiologists—whom she likely never meets, and where charges pile up item by item in what one recent study called a “wasteful overuse of drugs and technologies.” There is no evidence that such extravagance makes for better health care outcomes. The rates of maternal and infant death in the US are higher than in other industrialized nations, partly because the poor, minorities, and children are disproportionately uninsured.

For head-spinning price disparities, however, nothing compares to pharmaceuticals. Americans account for almost half the $1 trillion spent annually for prescription drugs worldwide, while comprising less than 5 percent of the world’s population. It is probably [i.e. definitely] no coincidence that the pharmaceutical industry spent almost twice as much on political lobbying between 1998 and 2020 as its nearest competitor, the insurance industry. . . .

Unquote.

Whenever the president is asked why he wants to eliminate the Affordable Care Act (which means people with “pre-existing conditions” would no longer be protected, among other things), he says he’s going to announce a beautiful replacement for the ACA “in two weeks”. Or “next month”. It’s always in two weeks or next month. Reporters never press him for details, because they know he’s full of crap.

Una volta un truffatore, sempre un truffatore (once a con man, always a con man).

PS:  Ezekiel Emanuel says different countries do different things very well, but if he had to choose his personal favorite, he’d pick healthcare in The Netherlands, with Germany, Norway and Taiwan in the running.

What a Concerned Person Might Do

It’s Monday afternoon and the resistance is heating up. There’s going to be a big demonstration in Washington on Wednesday. A human chain around the Capitol Building has been mentioned.

Meanwhile:

legumspiro

calls

Senators love hearing from people who live in their states. They also love hearing from nice people who claim to live in their states. Such people could try calling Senators through the main Senate switchboard at (202) 224-2131. But it’s often easier to get through to a Senator’s local office, in states like, for instance, Maine, Arkansas and Ohio (see list above).

Emails don’t have as much impact, but Senators also love getting them, especially from people who live in their states (or claim to). You can tell because their contact pages usually refer to the Senators by their first names. So it’s “Contact Jeff” or “Contact Susan”.

If a person wanted to send a nice but not quite accurate email to a Senator, despite not living in the Senator’s state, a person could:

Find a city in that state.

Bring up the map for that city.

Look for a part of town where affluent people probably live (usually somewhere on the outskirts where the streets are curvy or there are lakes or a country club nearby).

Identify a pleasant street name.

Use Zillow to find a nice house on that street. (Zillow will provide the Zip Code too!)

Look for a local business, school or church and save the phone number.

Find the Senator’s contact page. (They all look like Jeff’s.)

Then a person could enter some personal data, specifying a name of their choice, an address on that nice street with a street number of their choice, the Zip Code that Zillow provided, and maybe a phone number with the relevant area code and prefix.

Unfortunately, a person would also have to enter an email address, possibly twice, so it’s good if a person has  an innocuous email address that can be used to receive garbage emails. (I have one; maybe a person should have one too.)

After that, all a person would have to do is maybe select a topic (something like “Health”), possibly type in a subject (like “Senate Health Care Bill”) and then enter a polite plea to vote No on an upcoming piece of abominable legislation that relates to health insurance.

Perhaps something like this, but using a person’s own words: 

Dear Sen. XXX: Please vote No on the Senate Health Care Bill. You know in your heart that it’s a bad bill. It will harm the people of <XXX’s state>. Reporters say that moderate Republicans always give in to the GOP leadership at the last moment. Don’t let that happen, no matter what they promise. We are counting on you. Sincerely yours, <the name that a person chose to use>

I’m not recommending this, of course, because, as President Nixon famously pointed out, “it would be wrong”. But given the stakes (many people will unnecessarily suffer and die if this legislation passes), a concerned person might do it anyway.

 

What People Need to Know About Medicaid

Please share this 20-minute video, even with Americans who hate politics. It might reach people in Alaska, Arizona, Colorado, Louisiana, Maine, Nevada, Ohio or West Virginia who will call their relatively sane Republican Senators and demand that they vote No on the Better Healthcare Reconciliation Act, also known as the Senate healthcare bill or Trumpcare. We need to stop this abomination now.

If Only His Words Meant a Damn Thing

I wrote about the Republican healthcare bill earlier today:

Assuming logic and morality don’t win the day, and simple majorities pass the bill in both houses, it will go to the President. If that sleazeball cares what’s in the bill, he’ll veto it, since it won’t be anything like the health care bill he promised. But we know how much we can count on him.

What he’s promised:

No one will lose coverage. There will be insurance for everybody. Healthcare will be a “lot less expensive” for everyone — the government, consumers, providers….

“We’re going to have insurance for everybody,” Trump said in an interview with The Washington Post. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”…

As his run for president took shape, candidate Trump boasted via Twitter, “I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid”

Of course, a few weeks ago he celebrated the passage in the House of the AHCA (or Trumpcare), the legislation that would break all those promises!

So it was interesting to see this report later in the afternoon:

WASHINGTON (AP) — President Donald Trump told Republican senators Tuesday that the House-passed health care bill is “mean” and urged them to craft a version that is “more generous,” congressional sources said.

The president’s comments, at a White House lunch with 15 GOP senators, came as Senate Republican leaders’ attempts to write their own health care package have been slowed by disagreements between their party’s conservatives and moderates [i.e. the radicals and conservatives].

Trump’s remarks were a surprising critique of a Republican-written House measure whose passage he lobbied for and praised. At a Rose Garden ceremony minutes after the bill’s narrow House passage, Trump called it “a great plan.”

His comments also seemed to undercut efforts by Senate conservatives radicals to include restrictions in their chamber’s bill, such as cutting the Medicaid health care program for the poor and limiting the services insurers must cover. Moderate Conservative GOP senators have been pushing to ease those efforts.

The sources say the president did not specify what aspects of the bill he was characterizing….

One source said Trump called the House bill “mean, mean, mean” and said, “We need to be more generous, more kind”. The other source said Trump used a vulgar phrase to describe the House bill and told the senators, “We need to be more generous.”

It’s extremely unlikely that DT will know or care what’s in the bill he’s given to sign, and even less likely that he would veto it.

If we’ve learned nothing else since the election, it’s that his words don’t mean a damn thing. The Executive Branch of our government is being run by someone you wouldn’t trust to feed your cat or water your lawn.

What’s Their Deal With Health Insurance Anyway?

It feels odd to write about anything else now that a senseless, malevolent being has taken control of the White House, but here goes anyway:

Four years ago, Dr. Ben Carson, who is expected to be the U.S. Secretary of Housing and Urban Development in the new administration, compared the Affordable Care Act to slavery:

“You know, Obamacare is really I think the worst thing that has happened in this nation since slavery,” Carson … said … in remarks at the Values Voter Summit in Washington. “And it is in a way, it is slavery in a way, because it is making all of us subservient to the government, and it was never about health care. It was about control…”

“And why did [the Obama administration] want to pass it so badly? Well, as I said the other night on television, Vladimir Lenin … said that socialized medicine is the keystone to the establishment of a socialist state.”

As we might expect, there is no evidence that Lenin said any such thing. The “socialized medicine” quote attributed to him by Carson and others was fabricated for a 1949 brochure issued by the American Medical Association. That’s back when the AMA was fighting President Truman’s proposal for national health insurance (and years before they opposed Medicare). But Carson telling that tall tale helps explain why the Republican Party is so opposed to the Affordable Care Act.

The ACA requires individuals to have health insurance (or pay more income tax) and employers of a certain size to offer health insurance to their employees (or pay more income tax). It also requires that health insurance plans meet specific requirements in order to qualify as health insurance for purposes of the law. So that’s one reason Republicans want to repeal the ACA. The law requires that we do something for our own benefit or for the benefit of others. It limits our freedom to do whatever the hell we want. That makes it a prime example of government overreach, or what the right-wing calls the “Nanny State”.

But since Republicans are forced to buy insurance for their houses and cars without making a fuss (let alone bringing up slavery or Nazi Germany), being forced to buy insurance for their bodies (or their employees’ bodies) can’t be the only reason they’re against the ACA.

A second reason is simply political. After decades of trying, a Democratic President finally got a bill passed that takes us closer to universal health insurance. But whatever Obama was for, the Republicans were against. They immediately labeled the ACA as “Obamacare” to help convince right-wingers to oppose the law, even if they didn’t know what the law did (and even if the law would improve their own lives). 

That’s despite the fact that the ACA adopted the conservative approach to universal healthcare that Republicans had been advocating since the 1970s. It’s pretty amazing. A letter to the editor in The Chicago Tribune tells the disheartening story:

Obamacare is virtually the same privatized mandate plan [the Republican Party] pushed since President Richard Nixon first proposed the National Health Strategy in 1971, then again in 1974. Then the GOP revived its privatized mandate plan again in 1993 with … the [HEART] act … an alternative to the [Clinton] single-payer plan… 

Obama — as a compromise to have basic health reform passed — used this same GOP blueprint with one significant change: adding a public option alongside the GOP’s privatized mandate plan … 

Eventually the public option was stripped out of the 2010 ACA bill as a further compromise to attract bipartisan support for the bill, leaving in its place the very plan that the GOP wanted and pushed for decades. Unfortunately, the ACA did not receive a single vote from the Republican Party that created the plan’s primary concepts as an alternative to a single-payer — “Medicare for all” — type of system.

No wonder the Republicans have had so much trouble coming up with a replacement for “Obamacare”. The law they’re so against is the law they used to be for.

A third reason the Republicans oppose the ACA is that it’s the kind of Robin Hood economic redistribution Republicans hate. It takes from the rich and gives to the poor. Paul Krugman explains in a blog post called “Health Care Fundamentals”:

Providing health care to those previously denied it is, necessarily, a matter of redistributing from the lucky to the unlucky. And, of course, reversing a policy that expanded health care is redistribution in reverse. You can’t make this reality go away.

Left to its own devices, a market economy won’t care for the sick unless they can pay for it; insurance can help up to a point, but insurance companies have no interest in covering people they suspect will get sick. So unfettered markets mean that health care goes only to those who are wealthy and/or healthy enough that they won’t need it often, and hence can get insurance….

The thing is, however, that guaranteeing health care comes with a cost. You can tell insurance companies that they can’t discriminate based on medical history, but that means higher premiums for the healthy — and you also create an incentive to stay uninsured until … you get sick, which pushes premiums even higher. So you have to regulate individuals as well as insurers, requiring that everyone sign up — the mandate. And since some people won’t be able to obey such a mandate, you need subsidies, which must be paid for out of taxes…

What [the Republicans] are left with is … voodoo: they’ll invoke the magic of the market to somehow provide insurance so cheap that everyone will be able to afford it whatever their income and medical status. This is obvious nonsense [but] it’s all they’ve got.

The redistribution is related to a fourth reason they’re against the ACA and it might be their biggest reason of all. Not only did the ACA impose fines in the form of tax increases on taxpayers who wouldn’t buy health insurance, it included a separate, relatively large tax increase on the richest Americans. As everyone knows, that‘s anathema to Republican politicians. Repealing the ACA, therefore, would mean a big tax cut for the Republicans’ favorite people. From Slate:

One of the core, very simple things [the ACA] did was raise taxes on the wealthy in order to fund subsidized health care for more Americans. Couples earning more than $250,000 saw a 0.9 percent increase in their top Medicare tax rate, as well as a new, 3.8 percent Medicare surtax on investment income.

If Republicans have their way and successfully repeal the Affordable Care Act, those two taxes will be toast—which will mean a substantial break for some of the country’s wealthiest families. The liberal Center on Budget and Policy Priorities estimates that millionaires would see 80 percent of the benefits from those tax reductions. Based on the most recent IRS data, the think tank roughly projects that the 400 highest income households—which earned an average of more than $300 million each in 2014—would see a $2.8 billion annual tax cut, worth about $7 million on average per filer.

So that’s at least four reasons why Republicans want to scrap the Affordable Care Act:

1) It’s what they call the “Nanny State” in action. 

2) It was an important Obama accomplishment.

3) It’s the kind of redistribution Robin Hood was for and the bad guys were against.

4) It raised taxes, especially for the rich.

In conclusion, Republicans don’t necessarily want millions of Americans suffering and dying without medical treatment. Being concerned about that kind of thing is simply low on their list of priorities.