Sunday, October 23, 2011

Health history

By Bill Kraus

When Frances Perkins came to Washington as Franklin Roosevelt’s secretary of labor, she brought along a “to do” list. All of the programs that became the New Deal were on the list. Almost all of them were enacted. Most survived the displeasure of the U.S. Supreme Court.

Health care reform was on the list. The more urgent, Depression-driven items had a higher priority. By the time health care got to the top, it was pushed aside by the demands of World War II as were most social issues and a lot of other stuff as well.

When the war ended the new labor government in England put health care at the top of the priority list and passed what was called socialized medicine for that country.

Meanwhile, back in Washington President Truman (with the help and at the urging of still-Labor Secretary Perkins) presented his version of a national health care system to what he called “The 80th Worst Congress.”

Its chances of passing, which were dim to begin with--can anyone imagine anything called “socialist” passing the 80th Congress?--were killed off by the deadly duo of the American Medical Association and the U.S. Chamber of Commerce.

The people in charge of the effort to kill the Truman proposal were smart enough to make sure that they weren’t trying to beat something with nothing. The AMA exploited the power of the Chamber of Commerce to expand the fledgling health insurance industry by convincing its insurance company members to go into that business despite the dim prospects that any of these companies would make a profit in this new, low-price/high-cost business in which they had no experience.

Over time the insurance industry solved the profit problem and private health insurance became a member of the status quo which is committed to protecting the status quo against change.

The next major push for what has come to be labeled “health care reform” came from President Richard Nixon. Good sponsor. Bad timing. The Nixon idea fell out of favor along with President Nixon himself whose activist administration’s ideas were pushed aside by the Watergate scandals.

President Clinton’s pass at reform fell victim to incompetence, intellectual arrogance, and lack of transparency, otherwise known as the “We know what’s good for you; just shut up and take your medicine” syndrome.

Then along came President Obama and health care was at the top of an agenda again at last. He got a lot of what he wanted, but paid a terrible price for the half-victory. The Obama administration made two small mistakes which loom large in retrospect. Instead of characterizing the effort as a cost-control program which would make U.S. industry competitive in a flat world, they let it become a welfare program for the uninsured 40 million, which included a significant collection of deadbeats. Unpopular beneficiaries and unfortunate labeling. They also failed to find a respected, competent, high-profile Republican to do for Obamacare what former Republican Governor Winant did for Social Security for President Roosevelt as it was getting its sea legs in the '30s. Winant got it running and his presence at the top shielded it from all but the manic critics who lacked credentials and respect.

These oversights brought the shortsighted Chamber of Commerce into the battle against “socialized medicine” again despite the woes many their members were experiencing as they tried to price the products they were trying to sell abroad competitively despite the heavy price of providing health insurance for their employees that had to be built into their products’ costs.

The Obamacare outcome is undecided but at risk. Court challenges, cries for outright repeal, and even new limbs and transplants to the wounded corpus by more friendly therapists loom.

The hope of something worthy coming out of the current chapter in this 80-plus year old journey (to what? nowhere?) now rests on the hope that a polarized, paralyzed government can and will focus on the problem instead of the process, on ideas not ideology.

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