History of National Health Care in the US Frank Goeddeke, Jr., PhD January 25, 2010 RETIREES FOR SINGLE PAYER HEALTH CARE

First National Health Care Program Germany – 1883 Otto Van Bismark –Instituted health program to head off socialists Mandatory insurance –Employer-employee share premiums –Employee percentage of income –Gov’t pays unemployed premiums Approximately 200 private insurance plans today

United States Theodore Roosevelt –Republican –First proposed national health insurance plan –No country could be strong whose people were sick and poor

American Association of Labor Legislation AALL Bill in 1915 –Working class –Premiums shared by workers, employers, state American Medical Association originally endorsed it –State medical associations opposed American Federation of Labor opposed –Weaken unions role –Collective bargaining still not legally sanctioned Insurance industry opposed –AAL bill provided death benefits, cutting into life insurance market

Political Considerations WWI –Equated national health insurance with German Socialism Equated with Bolshevism

1920’s Medical profession is becoming more professionalized and effective Working-class people are utilizing medical services more Medical costs are now becoming more of a concern for workers than lost wages

1930’s Roosevelt’s Social Security Act of 1935 –Unemployment and old-age benefits more important than national health insurance –National health insurance left out of bill for tactical reasons Wagner Bill, National Health Act of 1939 –Federal grants to states –1938 elections conservative resurgence –Opposition to New Deal, etc.

1940’s Wagner-Murray-Dingell Bill 1943 –Compulsory health insurance –Payroll tax –Reintroduced every session for 14 years –Failed due to Red-Baiting Truman –Favored single payer, universal health insurance –Strong support by Truman –Dropped death benefit –AMA strongly fought this Assessed each member $25 to fight –Linked with communism Cold War Korean War After defeat, focus on collective bargaining for insurance

Medicare Truman’s universal health insurance defeat led to concentration on the aged only Grassroots support Signed into law 1965 AMA fought vigorously Compromises –Customary, reasonable, prevailing doctor fees –Hospital cost plus reimbursement –Medicare Part “B”

Clinton 1993 Employer mandate for HMO’s Universal coverage Died in Senate, Intense opposition

Bush 2003 Medicare Part D Drug benefits to Medicare Doughnut hole, etc. Give-away to insurance companies and pharmaceuticals

Obama Forced groups at the table early Stayed out of legislative process Heavily watered down Failed in Senate upon death of Kennedy

Lessons Do not underestimate the power of special interest groups! –AMA –Insurance industry –Free market conservatives Be bold early in term! Organize boldly, then compromise

Reframing Red-baiting doesn’t work like it used to Don’t want government getting bigger –Ask instead in which areas government should be involved and which they shouldn’t Should we outsource police departments? Defense? –Think of examples where free market is inefficient (look at current health care system!) –Would people rather have private insurers making health decisions?

Think of Unions Michigan right now with Dillon proposal to force public employees into one health insurance plan –Unions don’t like it! Some winners and some losers Bypasses contractual gains made over years Now, think of the following groups like they are a union –AMA –Insurance industry –SHRM, free market business What will it take to pacify these groups, so they can look past short-term interests to long-term?

Organizing The “base” wants single-payer, universal health insurance The party establishment doesn’t –We have to convince grass-roots in congressional districts before party will go along We should also think about accepting some compromises up front –Keep private insurance but regulate it more

The End Questions?