U.S. Presidents And Health Care Reform

The History Of Public Health Politics In America

Sep 10, 2009

For nearly one hundred years, U.S. Presidents have struggled with the complicated politics of health care reform and universal health insurance.

In a recent address concerning health care reform given to the Joint Houses of Congress, President Barack Obama remarked that “I am not the first President to take up this cause, but I am determined to be the last.” In this statement, the President was referring to nearly a century of health care politics in America. The origin of the current debate regarding the role of the Federal Government in the funding for, and the providing of, avenues of health care for American Citizens can be traced back to the late nineteenth century. This idea of populist reform can be seen in the awareness of the plight of working citizens found in literary works like Sinclair’s, The Jungle, and in the larger movement for political reform led by labor leaders and suffragists such as Eugene Debs and Lucy Stone.

The Roosevelt’s And The Reform Movement

The concept of government sponsored public welfare was synchronous with the increased power given to the State as citizens sought to regulate unsafe and unfair business practices. This new ideal was developed in detail in Croly’s, The Promise of an American Life, and manifested in the practices of nationalists like Theodore Roosevelt, who where quick to embrace the notion that the Federal Government should be a tool for progressive reform. Roosevelt was to fully champion the reform movement after his appointed successor, William Taft, failed to live up to Roosevelt’s expectations.

In the Presidential Campaign of 1912, Roosevelt left the Republican Party and joined the Progressive Party, which quickly came to be known as the Bull Moose Party in his honor. The Bull Moose platform, labeled as the “Square Deal”, included, for the first time in American politics, a plan to provide universal health insurance to all Americans. After Roosevelt’s defeat by Woodrow Wilson, some efforts were made by progressives to see health care legislation passed by congress. With out the support of the President, however, these efforts found little traction.

Some decades passed before the question of public welfare would again be directly addressed, this time by Theodore Roosevelt’s distant cousin, Franklin D. Roosevelt. As part of his “New Deal” platform, Franklin Roosevelt signed the Social Security Act of 1935. This legislation provided a safety net for the nation’s elderly, sick and disabled, and firmly placed the Federal Government in the role of public welfare administration.

Reform In The Modern Era

After World War II, President Henry Truman launched another effort advocating sweeping political and social reform which he called the “Fair Deal.” President Truman went so far as to make universal health care coverage part of the Democratic Party’s Platform. Although Truman was, in the end, forced to settle for a modest expansion of Social Security coverage, his platform was to be a direct influence over Lyndon Johnson’s proposals, outlined in his “Great Society” policy.

Initially,Johnson’s plan was called socialist and un-American by some conservatives, and he faced solid opposition from Congressional Republicans. Despite such resistance, Johnson was able to pass legislation implementing Medicare and Medicaid, which even further expanded the Federal Government’s role as a health care provider. However, these efforts still fell short of Truman’s originally proposed universal coverage.

President Richard Nixon followed up on Johnson’s “Great Society” by expanding the availability of the existing federal programs, and by taking a stand for universal health insurance. Although Nixon’s efforts originally met with harsh criticism, and he was accused as being too soft on big business, he was able to work with Democrats in Congress to create a compromise. The Nixon-Kennedy Healthcare plan of 1974 was seemingly on course for passage through Congress, but was derailed by the Watergate Scandal. By the time President Gerald Ford took office later that year, the country had begun to face economic difficulties, and concerns over frugality quashed all efforts to see health care reform legislation pass into law.

In retrospect, after his tenure in the White House in the late 1970’s, President Jimmy Carter said that, although he was a proponent of universal health insurance, the country’s economic difficulties at the time made health care reform politically unfeasible. During the early 1990’s however, while the country was enjoying a period of relative prosperity, President Bill Clinton again proposed a detailed plan to provide health care for all Americans. This plan, which was championed by then First Lady Hillary Clinton, was attacked as being overly intrusive by opponents, was successfully vilified by the broadcasts of the “Harry and Louise” ad campaign, and was again defeated in Congress.

Now, in the current proposals for reform as outlined by President Obama, a political learning curve is reflected, one that progressives have followed over nearly a century. While it seems that the ideal notion of universal health insurance is often successful as part of a populist platform, its implementation is always fraught with controversy. Whether it is seen as dangerously socialist, or it is claimed to be just too expensive, any sweeping health care effort made in the nation’s history has been met with fierce opposition. Although Obama intends to be the last President to have need to champion this cause, history shows that the politics of health care reform and universal health insurance have indeed become a cyclical process wherein there is gradually expanding coverage that is countered by the steady weight of the reluctance for rapid change.

Carter, Jimmy. A Government as Good As its People, (University of Arkansas Press ,May 1, 1996)

Croly, Herbert. The Promise of an American Life (The MacMillan Company, New York, 1909)

National Health Insurance—A Brief History of Reform Efforts in the U.S. (The Kaiser Foundation, March 2009)

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