Awhile back I put up a post concerning the “Medicare for All” movement and the difficulties we might have in this country in moving toward universal health care.
You can read about it here:
In it I argued that “Medicare for all” should not literally mean “Medicare for all” but universal health care available through a number of choices including a Federal program like Medicare as one available option.
It’s been half a century since the passage of Medicare for those over 65 years of age. I personally do not know how I would have survived without it. Yet even Medicare allows one to opt out and join a Medicare Advantage plan run by private insurers which promise greater benefits at lower cost. My own doctors have advised me to stick with original Medicare, which I have. I have not had a significant medical bill since I retired.
“Half a century later, we’re witnessing the early stages of yet another popular thrust toward single payer, increasingly billed as “Medicare for All.” The nomenclature intends to evoke associations with the popular, trusted program, and is perhaps easier for Americans to latch onto than a phraseology that threatens to trigger a tedious lesson in comparative health policy. But if the conceptual jump from Medicare to Medicare for All can serve as a rough model for achieving universal health care in the United States, we should also look to the history of the social movements that achieved something that then, too, seemed impossible.”
The 1964 Democratic Convention in Atlantic City
In August of 1964, 14,000 retirees arrived by the busload in Atlantic City. Representing the National Council of Senior Citizens (NCSC), the former railroad workers, dressmakers, and auto assemblers marched 10 blocks up the fabled New Jersey boardwalk to the Democratic National Convention at the Convention Hall. The group, which was organized and bankrolled by the AFL-CIO, moved en masse in floral housecoats and sandwich boards with slogans like “Our Illnesses Burden Our Families” and “Senior Citizens Vote, Remember Medicare.” They intended to push President Johnson to extend public health insurance to millions of Americans.
Astonishingly, less than a year later, they won. Medicare was signed into law in July of 1965 in Independence, Missouri, at a ceremony attended by former president Harry S. Truman, whose push for national health insurance (NHI) had collapsed nearly two decades before. The landmark law created a public-sector insurance pool for Americans 65 and over, which remains today the closest thing to a robust universal entitlement in the US health-care system. Its successful passage (which also passed Medicaid, to insure the very poor) stands in sharp contrast to multiple failed efforts to install a universal single-payer system.
The most viable push toward NHI in American history crumbled in the late 1940s, ruthlessly crushed by not only insurers and pharmaceutical companies but also the American Medical Association. (Physicians, whose already handsome salaries began to rise in the postwar era, feared the blow that NHI could strike to their paychecks, professional prestige, and autonomy, since a government payer would also reduce their control over prices.) As such, the AMA famously shook down its membership for $25 apiece to fund the multimillion-dollar campaign that injected the phrase “socialized medicine” into mainstream American culture.
“In this context, it’s perhaps tempting to view Medicare as a capitulation to industry pressure and political challenges, rather than as evidence they can be flouted. After all, Medicare (and, for that matter, Medicaid) targeted the most vulnerable patients. Many single-payer skeptics insist that Medicare managed to pass because it covered the people private insurance left behind.”
This viewpoint presents Medicare as a sort of compromise between the unfettered free market and the dashed dreams of the 1940s.
While insurance companies certainly fought against health-care-financing reforms, physicians associations and hospitals are typically considered to have been the more significant opponents—they believed Medicare to be a likely conduit for eventual full-scale single payer (and all the government interference they assumed would come with it), and struck back with more or less the same zeal that they mustered decades earlier. The AMA fought Medicare with “every propaganda tactic it had employed during the Truman era. Such tactics included a widespread media blitz, advertising in doctors’ offices, and visits to congressmen from physicians in their districts. One tactic, called “Operation Coffee Cup,” deputized physicians’ wives to host ladies’ gatherings, at which they’d play their guests an anti-Medicare PSA starring actor Ronald Reagan.
No one imagines expanding “Medicare” in one form or another to all Americans will be easy. Nothing quite like this has ever been accomplished in the United States. Yes, dozens of peer countries have built coherent, humane, universal health-care systems out of entrenched private ones.
Yes, mass movements have won major leftist reforms. Yes, advanced private industries of variou nations have been nationalized. But human history offers no examples of these things happening in combination, which is what winning Medicare for All will take.
Other countries’ publicly financed health-care systems were built atop systems far less entrenched and commodified than ours, and therefore presented far less of a threat to capitalism. The UK’s National Health Service—a fully socialized system of financing and delivery—sprouted from the wreckage of World War II, not high-performing investor-backed hospital chains.
Yet it is puzzling why American manufacturers, a group with enormous political clout that ought to welcome the discussion and be eager to overturn the existing model for healthcare. is on the sidelines. They are the ones who have to build the cost of subsidizing healthcare for their employees into their pricing structure, while most of their foreign competitors do not. Their competitors have the benefit of a national healthcare system taking care of their workers.
So why aren’t large corporations like Ford, GE, Apple and Hewlett-Packard lobbying for this? It would significantly reduce their costs. And they could compete for employees by offering ever-better supplement plans which would cost them far less than they are paying now.
The heads of these corporations have not lobbied for Medicare (and in fact have generally opposed it) because they feel that their class interests are at stake.
There has been vehement opposition from non-health care corporations to this type of “socialist” legislation, even though its enactment would greatly benefit these corporations’ bottom lines. But the non-health care corporations, including large manufacturers with major employee health cost burdens, stuck with the positions of the health industry lobby against their own corporate interests, and did so aggressively.
There is a more insidious possibility. Health insurance keeps employees chained to an employer. It is, in effect, a means by which employers can keep employees under their thumb. I know a lot of people who would quit their jobs tomorrow if an adequate and realistic alternative to their health care needs was in place.
But hen again there is always the possibility that Karl Marx’s class-based analysis was fundamentally correct.