By Christopher Young

Staff Writer

Healthcare reform has once again surged as the hot button topic in American politics. The America’s Affordable Health Choices Act has generated an inordinate amount of controversy. With all the arguments being made for and against healthcare reform, the history of American healthcare reform provides perspective on how the state of health care arrived at the current situation. Since Theodore Roosevelt, nearly every president has attempted to address healthcare reform in one way to another. Yet, every time healthcare became a pertinent issue, business rises up against. From “Hillarycare” to Lyndon Johnson’s Medicare system, the history of American healthcare reform is littered with very few successes and an overwhelming number of failed bills, due in large part to the forces of the medical industry and the insurance industry.

Teddy and Franklin, Health Care in the Public Eye

American healthcare reform has a history which stretches all the way to the turn of the 20th century. In 1912, Teddy Roosevelt was seeking another term as president but the Republican Party nominated instead William Howard Taft. Instead, Teddy Roosevelt created his own Bull Moose Party. In this period of time, America’s political scene was in turmoil. The Republican Party became the party of protectionism and of big business. However, they were also the party of trust busting. Unlike the Republicans today, they controlled the interests of the urban individuals and had a much more industrial voter base. The Democrats at this time were also very different. They absorbed many members of the defunct Populist Party and adopted many of the Populist’s pro-agriculture stances. Roosevelt’s Bull Moose Party represented a third path. Primarily comprised of Republicans, Bull Moosers were seen as anti-business and embraced a very populist rhetoric. One of the Bull Moose Party’s main goals was to create a form of government sanctioned healthcare for the country as a whole. Due to the intervention of big businesses he had alienated during his first two terms as well as the large advantage in infrastructure the Democrats and Republicans had, Roosevelt lost the election to Woodrow Wilson but his ideas would be reintroduced on mainstream politics in his fifth cousin, Franklin Delano Roosevelt.

Franklin Roosevelt inherited a country which was locked tightly in the Great Depression. To combat the growing economic instability, Roosevelt enacted the New Deal in 1933. The New Deal was a collection of programs designed to pro-vide support for American citizens and occurred in two phases. Part of the Second New Deal (1934-1936) was the legislation that eventually spawned the Social Security pro-gram Americans have today. When the bill was first introduced in 1935, it had all the provisions establishing the Social Security Administration but also included clauses establishing federally provided healthcare. The American Medical Association (AMA) was not pleased with Roosevelt’s bill and began lobbying against it tooth and nail. The AMA did not want the government interfering in medicine at all. Even with congress being exceptionally receptive to progressive ideas, healthcare reform was still a dangerous political issue. Threatened with the entire Social Security bill being shot down, Roosevelt decided to cut out the health care measures and so the Social Security Act of 1935 was born. Social Security was to be pro-vided by a payroll tax on workers’ wages. Because it did not tax businesses, the bill had very little effect on businesses. Also, many contemporary politicians believed that it would encourage elderly people to retire. At first, the bill only covered white male laborers but it would soon be expanded to minorities and women. As time went on, controversy over Social Security increased. The largest contemporary argument against Social Security is the eventual bankrupting of the Social Security Administration to the growing number of pensioners due to increasing lifespans. Currently, the United States spends 12.6% of its GDP on Social Security.

The Great Society, Medicare and Medicaid

After Roosevelt’s death in 1945, his successor Harry Truman pushed health care but never got a bill to vote in congress. His ideas would inspire further Democratic efforts to reform healthcare. In 1952, Dwight Eisenhower was elected to the presidency. He was a firm opponent of American healthcare but provided a ‘reinsurance plan’ which would support private insurance companies with federal subsidies. The bill was met with little support in congress and was voted down twice. After Eisenhower, John F. Kennedy and Lyndon B. Johnson entered office. Kennedy’s New Frontier plan included the intellectual predecessor to Medicare but he could not get it passed in congress. After Kennedy’s assassination, Lyndon Johnson unveiled his Great Society program, a series of progressive social reforms. One of the main focuses of the Great Society was an evolution of the Kennedy plan, Medicare and Medicaid. Johnson was presented with a rare political opportunity. Democrats outnumbered Republicans 2 to 1 in the House and nearly held that ratio in the Senate. However, even with these legislative advantages, healthcare reform faced many hurdles.

The American Medical Association and businesses once again interfered with the legislative process, introducing an alternate implementation. This plan was met with great resistance and was largely ignored. This left two more plans for the implementation of Medicare, the Presidential Medicare plan and the suggestions of a Republican representative from Wisconsin, John W. Byrnes. Byrnes created a plan which would enable federal medical insurance for the elderly to include physician’s services while simultaneously lowering taxes. The Johnson administration found some of Byrnes’ ideas to be very convincing and adopted them into their own plan. However, with all the services being provided, taxes would have to go up. They submitted the bill to congress. Even with this bill in congress, the bill underwent over 500 amendments before the Social Security Act of 1965 was passed. The bill amended the Social Security Act of 1935 and established Medicare and Medicaid. This was the first real victory for universal health-care. Medicare provided public health insurance for individuals over 65 and Medicaid allowed states to provide insurance to individuals receiving healthcare. Medicare was to be partially funded by a payroll tax on workers. The remainder of Medicare would be funded by a matching contribution from the employer with no exceptions. Medicare costs have been steadily increasing since its passage in 1960. In the fiscal year of 2007, Medicare costs reached $440b or 16% of all federal spending. Nonetheless, the passage of Medicare was a major step in generating support for a universal system which al-most happened with the very next president, Richard Nixon.

Nixon’s Near Miss and Hillarycare

Richard Milhous Nixon introduced the Comprehensive Health Insurance Act in 1974, the first bill to introduce a form of universal healthcare. The bill was comprised of two parts. The first mandated that all employers must purchase insurance for their employees. The second part would provide Medicaid like service to Americans who would pay for it. Much like the Obama healthcare plan, the Comprehensive Health Insurance Act would have effectively created a system where the federal government would directly compete with private insurance companies. Americans were expecting to see congress pass a universal health plan. However, scandal ruined the bill’s chances at going through congress. Watergate and the shaming of Nixon blacklisted any bills which had his name on it including the Comprehensive Health Insurance Act.

The next real attempt at healthcare reform came in 1993 under Bill Clinton’s presidency. A task force chaired by Hillary Rodham Clinton created a 1300 page bill which was Known amongst its detractors as “Hillarycare”, the bill stipulated that all Americans must be covered by health insurance whether government provided or privately provided. The Clinton ad-ministration took a very hard stance on the bill presented to congress. Known amongst its detractors as “Hillarycare”, the bill stipulated that all Americans must be covered by health insurance whether government provided or privately pro-vided. The bill also mandated that all employers needed to provide insurance to their employees. The Clinton administration took a very hard stance on the bill. The bill faced staggering opposition from medical organizations, including the AMA, and business owners. Al-though many businesses had health plans, their coverage is rather limited. In order to abide by the new legislation, most businesses would have to expand their coverage by millions of dollars. Health providers and insurers were against the bill because they felt they could not compete with the federal government. Also, medical professionals were against the bill because they believed that healthcare reform would actually increase cost of care and thus limit them to providing subpar care. The bill died despite being pushed in a heavily Democratic congress.

Senate Majority Leader George Mitchell proposed a compromise bill but there was not enough Democratic faith in healthcare reform to push the new bill through. In response to this failure, Hillary Clinton along with Democratic Senator Ted Kennedy and Republican Senator Orrin Hatch created the State Children’s Health Insurance Plan in 1997. SCHIP allowed federal and state governments to work together in order to provide insurance to qualifying children. The bill was funded by increased cigarette taxes and allowed for block grants given to states specifically for medical insurance for children. The tobacco industry was largely unaffected by this first tax with their revenues not decreasing much, however, with the resigning of this bill in 2009 by the Obama industry, SCHIP faces a new hurdle.

The Obama administration expanded the tax to all tobacco products as well as increasing them. Again, the tobacco industry is projected to stay largely un-affected. However, stores which primarily run on tobacco sales such as corner stores are now facing a crisis to stay open. After the passage of SCHIP, the next change in health care came with George W. Bush in 2003. George W. Bush expanded Medicare to cover drug prescriptions which was viewed as a major victory for healthcare reform from an admitted opponent of health-care reform.

America’s Affordable Healthy Chioces Act

One of Barack Obama’s first acts in office was to propose a health care bill. Although many viewed this as an extremely risky political move so early in his presidency, Obama believed that his victory over John McCain gave him a political mandate to reform healthcare. The result was the America’s Affordable Health Choices Act of 2009. In order for the act to become law, both houses of congress must pass a version of the bill which would then be unified by a joint committee. Then the new bill will once again be voted on and sent to the president. There are currently two senate versions of the bill which have not yet passed a vote. The bill in its current house form is very similar to Nixon’s Comprehensive Health Insurance Act and uses many of the same ideas.

In November, it was passed in the House of Representatives, 215-200 with the only Republican vote coming from Representative Anh ‘Joseph’ Cao of Louisiana. Elements of the bill include a tax on married individuals with a joint adjusted gross income of $350,000 as well as businesses who fail to provide the required level of healthcare coverage. The bill also prohibits cancellation of plans unless there is evidence of fraud. The bill also creates a slew of commit-tees as well as expanding Medicaid coverage and payments to physicians. The current draft of the bill would essentially set up the government as a competitor to private insurance firms. One of the criticisms of the Health choices act is that the public option would drive private insurance firms out of business. This was the case in other industrialized nations where the government offered a public option such as in the United Kingdom.

Instead of only a public option, private companies found they could not compete with the resources of the federal government and are now marginalized to a limited portion of the market. The costs of the bill would also be immense. Congressional Budget Office, a non-partisan organization, estimated that the healthcare reform bill in its current state will increase the federal deficit by $216 billion from 2010 – 2019. How-ever, many critics of the bill indicate that this only represents the monetary cost and that the cost may be higher due to the costs of medical care increasing in response to the passage of the bill.

The history of healthcare in America is a history of failure and opposition. Ever since 1912, healthcare reform has been in the political sphere but very few results have come from the discourse. Yet, even with most of the failed attempts at reform, many of the ideas existing in the Affordable Health Choices Act can be traced to previous health bills. The cur-rent bill represents a natural evolution of previous congressional bills. The future of this bill is still clearly in doubt, but the bill itself represents a continuing political battle which started in the mind of a president in 1912.