Health Care Déjà Vu
Can reform that does not build on the universal right to health care be successful?
See if you recognize this story: A small group of academics and analysts come together to propose reforms to the U.S. health care system.
They want to help workers, the elderly, the poor, and others whose needs aren't being met. But instead of working with those groups, they try to gain the acceptance of industries whose interests are threatened. Popular movements have no sense of ownership, doubt that the plan will work, and offer little support. The health care industry mobilizes against the plan, calling it socialist, and it never becomes law.
Flashing back to the Clinton bill of 1993? Predicting how the Obama plan will turn out? Actually, I was describing a proposal made in 1915. Though favorably reviewed by congressional and state commissions, the proposal's only partial legislative success was in New York, where protesting women suffragists and trade unionists had added it to their demands. Elsewhere, the reformers' emphasis on lobbying and research alone couldn't build the necessary momentum. Meanwhile, insurance companies, conservative politicians, and business and physicians' organizations derided the proposal and compared it to Bolshevism.
For the rest of the century, health care reform efforts—one led by the Committee on the Cost of Health Care in the 1920s, the short-lived inclusion of health coverage in the New Deal, the Wagner-Murray-Dingall bill of the Truman era, and, of course, the Clinton plan—followed the same storyline.
In each case, says historian Beatrix Hoffman, "the relentless opposition of medical, business, and insurance interests pushed reformers to design health care proposals around placating their opponents more than winning popular support. In turn, ordinary people had trouble rallying around complex proposals [that didn't recognize] a universal right to health care."
The root of the problem, Hoffman says, was that the proposals came from elites who sought to compromise with interest groups, where they believed real power lay, rather than to ally with grassroots movements. Reformers gave up too soon-folding to entrenched interests before assessing the strength of their own hands. They failed to enlist the support of the majority of Americans who favored public health care, just as they failed to unite the diverse, already mobilized social movements—like those for civil and women's rights, organized labor, or, later, for AIDS and cancer funding—that considered it a worthy, but politically unlikely, goal.
This same dynamic still operates today. Reformers and opponents alike have treated this latest attempt as a political game—what concessions can (or should) be squeezed from powerful industries?—rather than as the righting of an injustice that concerns us all.
Our failure to reframe the issue is part of the reason that, though we've been at it since 1915, we're the only industrialized nation without universal access to health care.
But this time, we may have a chance to transform the debate. The broad, committed, grassroots movement that was missing before is beginning to take its rightful place in the equation: marching in the streets, petitioning Congress for real solutions, and mobilizing to debunk the myths spread by industry.
Still, we can only get so far unless we learn from past failures. A plan that ignores the demands of the people in favor of industry (say, by leaving a single-payer system off the table) runs the risk of losing that crucial grassroots support. The belief that health care is a human right and ought to be universally accessible in a country as rich as ours is not just a good idea in itself. It's a powerful rallying cry, necessary for achieving the sustained grassroots momentum we need to succeed this time around.
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