The Long, Long Battle For Health Care Reform

So in this week of epochal Supreme Court opinions, even health policy wonks would not claim that King v. Burwell can match Obergefell v. Hodges in terms of its historical significance. There’s a reason the latter is stimulating spontaneous outbreaks of happiness among people who aren’t political and don’t follow constitutional law.

But at Vox today, Dylan Matthews reminds us that of the incredibly long hard path this country has followed to reach even the Affordable Care Act’s first timorous steps towards universal health coverage. Those conservatives who talk as though no one has ever seriously considered such a socialist abomination until now really are betraying their ignorance about history:

National health insurance has been the single defining goal of American progressivism for more than a century. There have been other struggles, of course: for equality for women, African-Americans, and LGBT people; for environmental protection; against militarism in Southeast Asia and the Middle East. But ever since its inclusion in Teddy Roosevelt’s 1912 Bull Moose platform, a federally guaranteed right to health coverage has been the one economic and social policy demand that loomed over all others. It was the big gap between our welfare state and those of our peers in Europe, Canada, Australia, New Zealand, and Japan.

And for more than a century, efforts to achieve national health insurance failed. Roosevelt’s third-party run came up short. His Progressive allies, despite support from the American Medical Association, failed to pass a bill in the 1910s. FDR declined to include health insurance in the Social Security Act, fearing it would sink the whole program, and the Wagner Act, his second attempt, ended in failure too. Harry Truman included a single-payer plan open to all Americans in his Fair Deal set of proposals, but it went nowhere. LBJ got Medicare and Medicaid done after JFK utterly failed, but both programs targeted limited groups.

Richard Nixon proposed a universal health-care plan remarkably similar to Obamacare that was killed when then-Sen. Ted Kennedy (D-MA) walked away from a deal to pass it, in what Kennedy would later call his greatest regret as a senator. Jimmy Carter endorsed single-payer on the campaign trail, but despite having a Democratic supermajority in Congress did nothing to pass it. And the failure of Bill Clinton’s health-care plan is the stuff of legend.

Yes, Obamacare haters may dismiss the experience of virtually every other wealthy country by intoning “American exceptionalism”, as though we have some long-cherished right to die young that’s as essential to the national character as unlimited possession of guns. But this has been a constant issue in our own country, too, and it’s a token of how far our political system has drifted to the right that redeeming the vision of Teddy Roosevelt and Harry Truman and Richard Nixon strikes so many people as a horrifying lurch into socialism.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.