Undernews is the online report of the Progressive Review, edited by Sam Smith, who has covered Washington under nine presidents and edited alternative journals since 1964. The Review has been on the web since 1995. See main page for full contents

January 16, 2009


Lillian B. Rubin, Dissent Magazine - The history of the struggle for health care in the United States is a long and bitter one, going back to 1945 when President Harry Truman asked the Congress to enact a national insurance program "to assure the right to adequate medical care and protection from the economic fears of sickness." A coalition of conservative groups, led by the implacable opposition of the American Medical Association and fueled by the insurance and pharmaceutical industries, denounced the Truman plan as "socialistic," stoked public fears about freedom and choice, and defeated the legislation. . .

The same scenario was repeated in 1960 when, with the support of President John F. Kennedy, Medicare's backers introduced yet another bill to provide health care for America's aged. Only this time, the AMA, with the help of the wives of physicians across the country, organized what was known as "Operation Coffee Cup" and enlisted a B-movie actor named Ronald Reagan, who was then host of the popular Sunday night television program General Electric Theater, to warn, "One of the traditional methods of imposing statism or socialism on a people has been by way of medicine."

Reflecting on the campaign against Medicare, Drew Pearson, a well-known Washington columnist at the time, wrote "Ronald Reagan of Hollywood has pitted his mellifluous voice against President Kennedy in the battle for medical aid for the elderly. As a result it looks as if the old folks would lose out. He has caused such a deluge of mail to swamp Congress that Congressmen want to postpone action on the medical bill until 1962. What they don't know, of course, is that Ron Reagan is behind the mail; also that the American Medical Association is paying for it. . . . Just how [Reagan's] background qualifies him as an expert on medical care for the elderly remains a mystery. Nevertheless, thanks to a deal with the AMA, and the acquiescence of General Electric, Ronald may be able to out influence the President of the United States with Congress."

It took President Lyndon Johnson, a former Senate leader who knew where all the congressional bodies were buried, to twist enough arms in Congress to stiffen its spine. On July 30, 1965, the years of struggle finally paid off. President Johnson signed into law Title XVIII of the Social Security Act establishing Medicare and its companion program, Medicaid, which insures indigent Americans. The nation had its first (and still only) government-sponsored, single-payer medical system. . .

Despite the immense popular support for Medicare, the program continued to grate on conservative sensibilities, and by the early 1980s the conservatism of the Reagan administration-its distaste for what it called "social engineering," which meant any federally financed benefit programs-began to make itself felt. But the same voices that were railing against entitlements like Medicare were silent when the program was amended to cover the federal judiciary, members of Congress, and the president. No cries of socialism arose, no concerns about the cost of entitlements, no jeremiads about freedom and choice were heard from the congressional opposition or President Reagan when it was their turn to get government-sponsored health care.

With all the controversy, however, it wasn't until 1995, after the Clinton administration's failed attempt at universal health care, that the Republican Congress, urged on by Speaker of the House Newt Gingrich and backed strongly by the insurance companies, passed the Medicare Reform Bill, which was much less a step toward reform than a walk toward privatization. But it couldn't have happened without the support from some Democrats and the signature of President Bill Clinton. . .

Ultimately, the alleged reforms meant, among other things, an increased reliance on private insurance companies-subsidized by the federal government-for the delivery of care. It looked like a good deal at first, with grand promises from the insurance companies of more care for less money, and Medicare recipients flocked to the health maintenance organizations. . . But it wasn't long before many of us found out that an insurance company's public relations campaign has little relation to reality, and their promises melted away before the imperative of the bottom line. So, for example, when my husband developed a persistent urinary-tract infection that our primary care doctor kept treating unsuccessfully, I finally asked him why he wasn't referring the problem to a urologist. He hemmed and hawed, shifted his feet, dropped his eyes, and finally said almost shamefacedly, "These HMOs are making it harder and harder to make that kind of referral." I immediately switched back to Medicare, where a physician's judgment is still generally the deciding factor in specialist care. . .

Then came the Bush years. From its earliest days, this administration's hostility to Medicare and Social Security has been no secret. It lost the fight to privatize Social Security, but the war against Medicare continues as it pushes people into HMOs by increasing the monthly cost for Medicare, cutting services, and reducing payments to hospitals and doctors until the very existence of the program is threatened. As long ago as 2005, an AMA survey reported that nearly 40 percent of 5,486 physicians said that if the projected 5 percent cuts were to pass, they would "curtail the number of new Medicare patients they accept into their practices." . . .

Unfortunately, the election campaign now under way offers little hope of substantial improvement in the health care crisis that now afflicts this nation. For despite what the privatization of Medicare has taught us about the incompatibility of for-profit insurance companies with quality patient care, and despite the fact that federal subsidies to these corporations are substantially more costly to taxpayers than the government-run Medicare, no candidate dares to propose the only universal health care plan that will work: a government-sponsored, single-payer system along the lines of the original Medicare
-a program that worked just fine until a coalition of conservative forces, insurance companies, the pharmaceutical industry, and right-leaning and/or fearful Democrats disassembled it.

All this, and I haven't even mentioned the huge multi-billion-dollar boondoggle the federal government handed the insurance companies and the pharmaceutical industry with Medicare Part D, the prescription drug benefit that went into effect on January 1, 2006. It would take another whole article to discuss the many-tiered problems with this program.

Lillian B. Rubin is with the Institute for the Study of Social Change, University of California, Berkeley. She is a sociologist, psychologist, and author of numerous books, including, most recently, 60 on Up: The Truth about Aging in America (Beacon Press, 2007).


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