A Century of Health Care Reforms, Successes and Failures

The Sept. 30 deadline to repeal and replace the Patient Protection and Affordable Care Act – aka ACA or ObamaCare – under the terms of Reconciliation (that is, with only 51 votes in the Senate instead of 60) approaches. Early estimates are that Graham-Cassidy would result in fewer Americans covered than either the House’s American Health Care Act (AHCA) or the Senate’s earlier Better Care Reconciliation Act (BCRA), it currently seems to have a decent chance at passage.

While the much maligned Congressional Budget Office analysis hasn’t come out yet, the (admittedly left-leaning) Center on Budget and Policy Priorities says the Graham-Cassidy bill could result in 32 million fewer people having healthcare coverage in 10 years and cut federal funding for health care by more than $400 billion. Estimates for AHCA and BCRA were 22 million and 23 million fewer, respectively.

Meanwhile a bipartisan group of lawmakers are trying to shore-up the ACA if repeal-and-replace efforts fail again, and Senator Bernie Sanders has introduced a single-payer “Medicare for All” bill.

If none of these pass, they will be in good company. Health care reform has always been a hard-sell in the US since at least 1912, when even the American Medical Association opposed it. What was impressive about ACA, whether you liked it or not, was that – imperfect as it was – it passed, with AMA support.

Earlier attempts at “universal health care” included:

  • Theodore Roosevelt’s Progressive “Bull Moose” Party proposed National Health Service for “the protection of the home life against the hazards of sickness” in 1912. It died alongside his hopes for a third presidential term.

  • The Progressives tried again in 1915, but a negative campaign comparing it to a compulsory health-insurance program in our World War I adversary Germany.

  • In the 1920s the Committee on the Costs of Medical Care proposal was similarly denounced (for the first but not the last time) as “socialized medicine”.

  • While President Franklin Delano Roosevelt’s didn’t propose health care reform (he was preoccupied with Social Security, the New Deal and World War II), wartime wage and price controls indirectly led to employers offering workers health insurance coverage in lieu of salary raises.

  • Roosevelt’s successor, President Harry Truman, recommended to the creation of a National Health Insurance Board administering universal health insurance coverage. Congress failed to act on it, possibly due to more opposition from AMA, including a renewed charge of socialized medicine, now linked to Communism.

  • More modest reforms were attempted under Presidents Dwight D. Eisenhower and John F. Kennedy, who tried and failed to extend medical benefits to Social Security recipients, again under fire from AMA.

  • Despite the AMA’s continued opposition, President Lyndon B. Johnson managed to enact Medicare and Medicaid.

  • President Richard Nixon managed to pass the Health Maintenance Organization Act, though the proposed National Health Insurance Standard Act, requiring employers offer minimum levels of health coverage, failed.

  • President Jimmy Carter also proposed universal health care, but Congress never let it out out of committee. Possible reasons include the Recession or maybe Democratic Party rival Ted Kennedy wanting to hold on to his signature issue.

  • The Medicare Catastrophic Coverage Act was enacted by President Ronald Reagan. Congress repealed much of it during President George H.W. Bush’s term.

  • President Bill Clinton (and First Lady Hillary Clinton) universal coverage plan, the American Health Security Act, failed to pass, but he did get through The Health Insurance Portability and Accountability Act and the State Children’s Health Insurance Program.

  • President George W. Bush increased prescription drug benefits under Medicare Part D with the unpopular (to Congress) Medicare Drug Improvement and Modernization Act.

  • President Barack Obama’s ACA, the closest thing to universal health care he could get through Congress (though without a single Republican vote), was endorsed by the AMA. Whatever its reasons – conspiracy theories abound – it continues to endorse ACA and advocates for no repeal without replacement.

Whether Graham-Cassidy passes or not, and in what form – maybe restoring the requirements for coverage of pre-existing conditions or essential benefits for mental health and substance abuse coverage – American health care coverage will likely continue to evolve.

The ever-increasing costs of health care and prescription drugs, the opioid epidemic and the need for substance abuse treatments for all – whether a bare-bones public 12-step program like Narcotics Anonymous or the best alcohol rehab centers – and the aging, long-lived and unhealthy elderly population should ensure that the issue remains front-and center for a long time.

BIO: Stephen Bitsoli writes about addiction, substance abuse, and recovery. A journalist for more than 20 years, and a lifelong avid reader, Stephen loves learning and sharing what he’s learned.

Calling All Cyclists: Let These Road Safety Tips Ring Your Bell

Next Story »

Dwayne Johnson: President of The United States?