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Sun Mar 30, 2014, 07:21 PM

A Brief History: Universal Health Care Efforts in the US

A Brief History: Universal Health Care Efforts in the US

(Transcribed from a talk given by Karen S. Palmer MPH, MS in San Francisco at the Spring, 1999 PNHP meeting)

Late 1800’s to Medicare

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US circa 1883-1912, including Reformers and the Progressive Era:

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Theodore Roosevelt 1901 — 1909

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AALL Bill 1915

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FDR’s first attempt — failure to include in the Social Security Bill of 1935...We might have thought the Great Depression would create the perfect conditions for passing compulsory health insurance in the US, but with millions out of work, unemployment insurance took priority followed by old age benefits. FDR’s Committee on Economic Security, the CES, feared that inclusion of health insurance in its bill, which was opposed by the AMA, would threaten the passage of the entire Social Security legislation...FDR’s second attempt — Wagner Bill, National Health Act of 1939...there was one more push for national health insurance during FDR’s administration: The Wagner National Health Act of 1939. Though it never received FDR’s full support, the proposal grew out of his Tactical Committee on Medical Care, established in 1937. The essential elements of the technical committee’s reports were incorporated into Senator Wagner’s bill, the National Health Act of 1939, which gave general support for a national health program to be funded by federal grants to states and administered by states and localities. However, the 1938 election brought a conservative resurgence and any further innovations in social policy were extremely difficult. Most of the social policy legislation precedes 1938. Just as the AALL campaign ran into the declining forces of progressivism and then WWI, the movement for national health insurance in the 1930’s ran into the declining fortunes of the New Deal and then WWII.

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Wagner-Murray-Dingell Bills: 1943 and onward through the decade

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Truman’s Support

After FDR died, Truman became president (1945-1953), and his tenure is characterized by the Cold War and Communism. The health care issue finally moved into the center arena of national politics and received the unreserved support of an American president. Though he served during some of the most virulent anti-Communist attacks and the early years of the Cold War, Truman fully supported national health insurance. But the opposition had acquired new strength. Compulsory health insurance became entangled in the Cold War and its opponents were able to make “socialized medicine” a symbolic issue in the growing crusade against Communist influence...Truman’s plan for national health insurance in 1945 was different than FDR’s plan in 1938 because Truman was strongly committed to a single universal comprehensive health insurance plan. Whereas FDR’s 1938 program had a separate proposal for medical care of the needy, it was Truman who proposed a single egalitarian system that included all classes of society, not just the working class. He emphasized that this was not “socialized medicine.” He also dropped the funeral benefit that contributed to the defeat of national insurance in the Progressive Era. Congress had mixed reactions to Truman’s proposal. The chairman of the House Committee was an anti-union conservative and refused to hold hearings. Senior Republican Senator Taft declared, “I consider it socialism. It is to my mind the most socialistic measure this Congress has ever had before it.” Taft suggested that compulsory health insurance, like the Full Unemployment Act, came right out of the Soviet constitution and walked out of the hearings. The AMA, the American Hospital Association, the American Bar Association, and most of then nation’s press had no mixed feelings; they hated the plan. The AMA claimed it would make doctors slaves, even though Truman emphasized that doctors would be able to choose their method of payment.

In 1946, the Republicans took control of Congress and had no interest in enacting national health insurance. They charged that it was part of a large socialist scheme. Truman responded by focusing even more attention on a national health bill in the 1948 election. After Truman’s surprise victory in 1948, the AMA thought Armageddon had come. They assessed their members an extra $25 each to resist national health insurance, and in 1945 they spent $1.5 million on lobbying efforts which at the time was the most expensive lobbying effort in American history. They had one pamphlet that said, “Would socialized medicine lead to socialization of other phases of life? Lenin thought so. He declared socialized medicine is the keystone to the arch of the socialist state.” The AMA and its supporters were again very successful in linking socialism with national health insurance, and as anti-Communist sentiment rose in the late 1940’s and the Korean War began, national health insurance became vanishingly improbable. Truman’s plan died in a congressional committee. Compromises were proposed but none were successful. Instead of a single health insurance system for the entire population, America would have a system of private insurance for those who could afford it and public welfare services for the poor. Discouraged by yet another defeat, the advocates of health insurance now turned toward a more modest proposal they hoped the country would adopt: hospital insurance for the aged and the beginnings of Medicare.

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Why did these efforts for universal national health insurance fail again?

For may of the same reasons they failed before: interest group influence (code words for class), ideological differences, anti-communism, anti-socialism, fragmentation of public policy, the entrepreneurial character of American medicine, a tradition of American voluntarism, removing the middle class from the coalition of advocates for change through the alternative of Blue Cross private insurance plans, and the association of public programs with charity, dependence, personal failure and the almshouses of years gone by.

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Johnson and Medicare/caid

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- more -

http://www.pnhp.org/facts/a-brief-history-universal-health-care-efforts-in-the-us


Here is Truman expressing his disappointment for having failed to deliver universal health care:

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By mid-1951 the AMA was openly claiming victory, and President Truman acknowledged as much when he omitted the proposal from his 1952 state of the Union message. Instead, he announced the establishment of a Commission on the Health Needs of the Nation to study the problem. In the presidential election that year, the Democratic candidate, Adlai E. Stevenson (who replaced the retiring President as the party's standard bearer, skirted the issue of Government health insurance. On the other hand, the winner, Dwight D. Eisenhower, voiced strong opposition to the proposal, ensuring that the new administration would not soon revive it.

In sum, the Wagner-Murray-Dingell bill was the victim of a cautious Congress, massive resistance by a prestigious and vitally affected interest group, sympathy for the AMA's position from an imposing array of nonmedical groups, a lack of wholehearted support from some of the key proponents, considerable antipathy from the press, the rapid growth of private insurance, and, finally, of a hostile political climate. (12)

Years later, President Truman wrote: "I have had some bitter disappointments as President, but the one that has troubled me most, in a personal way, has been the failure to defeat the organized opposition to a National compulsory health insurance program. But this opposition has only delayed and cannot stop the adoption of an indispensable Federal health insurance plan."

http://www.ssa.gov/history/corningchap3.html

Truman's words are still applicable.

President Obama ensured that significant legislation passed, and the opposition "cannot stop the adoption of an indispensable Federal health insurance plan."

ACA Is On Fire - Obamacare Now A "Third Rail"
http://www.democraticunderground.com/10024747036

"All but seven states have single payer activist groups."
http://www.democraticunderground.com/10024747402




19 replies, 3747 views

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Always highlight: 10 newest replies | Replies posted after I mark a forum
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Arrow 19 replies Author Time Post
Reply A Brief History: Universal Health Care Efforts in the US (Original post)
ProSense Mar 2014 OP
steve2470 Mar 2014 #1
jeff47 Mar 2014 #2
ProSense Mar 2014 #14
sheshe2 Mar 2014 #3
ProSense Mar 2014 #6
treestar Mar 2014 #4
ProSense Mar 2014 #7
leftstreet Mar 2014 #5
ProSense Mar 2014 #8
ProSense Mar 2014 #13
Cha Mar 2014 #9
LineLineNew Reply .
ProSense Mar 2014 #10
Cha Mar 2014 #11
ProSense Mar 2014 #12
Cha Mar 2014 #15
ProSense Mar 2014 #16
Cha Mar 2014 #17
ProSense Apr 2014 #18
Cha Apr 2014 #19

Response to ProSense (Original post)

Sun Mar 30, 2014, 07:40 PM

1. k&r ! nt

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Response to ProSense (Original post)

Sun Mar 30, 2014, 08:11 PM

2. But we could have gotten Lieberman's vote this time!!

Somehow.....I can't be specific, but I'm absolutely sure it would have passed if Obama tried harder.

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Response to jeff47 (Reply #2)

Mon Mar 31, 2014, 06:19 PM

14. Yeah.

He can work miracles, don't you know?

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Response to ProSense (Original post)

Sun Mar 30, 2014, 08:20 PM

3. Truman's words, on the organized opposition,

as you said, as true today as it was then.

Thank you, PS.

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Response to sheshe2 (Reply #3)

Sun Mar 30, 2014, 08:48 PM

6. Yup. n/t

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Response to ProSense (Original post)

Sun Mar 30, 2014, 08:23 PM

4. a good perspective

Clinton's attempt, too.

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Response to treestar (Reply #4)

Sun Mar 30, 2014, 09:40 PM

7. Yup, great details. n/t

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Response to ProSense (Original post)

Sun Mar 30, 2014, 08:26 PM

5. Universal Health INSURANCE Efforts, not care n/t

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Response to leftstreet (Reply #5)

Sun Mar 30, 2014, 11:12 PM

8. More than a century. n/t

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Response to leftstreet (Reply #5)

Mon Mar 31, 2014, 09:30 AM

13. Here's a good piece

Hospitals chart ways to boost care, funding under ACA
http://www.democraticunderground.com/10024757937

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Response to ProSense (Original post)

Sun Mar 30, 2014, 11:15 PM

9. 2010 Signed into LAW.. WHINE WHINE WHINE WHINE WHINE WHINE WHINE WHINE WHINE WHINE

thanks PS

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Response to ProSense (Reply #10)

Mon Mar 31, 2014, 02:00 AM

11. BFD

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Response to Cha (Reply #11)

Mon Mar 31, 2014, 08:26 AM

12. Yup. Adding this:

Obamacare not only ushered in universal health care, but also is providing the impetus for single payer.

A Brief History: Universal Health Care Efforts in the US
http://www.democraticunderground.com/10024755799

From the article posted here. http://www.democraticunderground.com/10024757591

Even as the Affordable Care Act is in its nascent stages, some states are already looking toward 2017 when they can request waivers to opt out of the healthcare exchanges. And a small, but persistent, movement has popped up toward a single payer system as an alternative to participating in the exchanges.

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Robin Lunge, Vermont’s director of healthcare reform, said that Vermont’s goal is to move the issue of healthcare completely away from the employer. Vermont’s single payer system, she said, would be similar to the one state employees are already on. It would be financed through an employer and individual tax as well as the premium tax credits and subsidies provided through the exchanges.

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The state’s Medicare, Medicaid and Veteran’s Administration programs would continue to operate as usual under a plan similar to Vermont’s. In Vermont’s potential single payer system, the system would act as a supplement to government insurance and cover everyone who is uninsured or part of the current state health exchanges.


Vermont single payer move has been fully funded by Obamacare.

Lessons from Vermont's Health Care Reform

By Laura K. Grubb, M.D.
The New England Journal of Medicine, April 4, 2013

In May 2011, Vermont Governor Peter Shumlin signed legislation to implement Green Mountain Care (GMC), a single-payer, publicly financed, universal health care system. Vermont's reform law passed 15 months after the historic federal Affordable Care Act (ACA) became law. In passing reforms, Vermont took matters into its own hands and is well ahead of most other states in its efforts to implement federal and state health care reforms by 2014. The Supreme Court decision last June to uphold most of the ACA left many states scrambling, since they had postponed reforms pending the judgment. Although Vermont is a small state, its reform efforts provide valuable lessons for other states in implementing ACA reforms.

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Finally, Vermont policymakers are maximizing federal financing and have projected cost savings. In January 2013, the state released a 156-page financing plan for its single-payer arrangement; the plan outlines federal financing sources and the anticipated generation of savings. Vermont has been awarded more than $250 million in federal funding for its state exchange — the fifth-highest amount among the states, although Vermont has the country's second-smallest state population. “We feel strongly that the exchange is not the answer to all of Vermont's health care problems,” Shumlin remarked, explaining that “the exchange is helpful to Vermont to bring us federal dollars to achieve our single-payer goal.”3 In fact, state exchange development will be 100% federally funded.4

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http://www.pnhp.org/news/2013/april/lessons-from-vermonts-health-care-reform

For everyone who has a problem with ACA--
http://www.democraticunderground.com/10024747402

The linked to at the top also mentions the VA and drug pricing.

Obamacare improved the Medicaid drug rebate program, which is one of the best.

Issue Brief - Medicare Drug Negotiation and Rebates

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Best Price. A third argument is that it makes sense for Medicare to receive the best price available for prescription drugs, just like Medicaid and the VA. In Medicaid, the drug manufacturer provides the federal government discounts for drugs, which are shared with the states. The discount is either the minimum drug amount or an amount based on the best price paid by private drug purchasers, whichever is less. Current law requires drug companies to charge Medicaid 23 percent less than the average price they receive for the sale of a drug to retail pharmacies. Drug companies also must provide another discount if a drug’s price rises faster than the rate of inflation (Thomas and Pear, 2013)...Medicaid rebates, if applied to Part D, would save the federal government money. According to a 2011 study conducted by the Office of the Inspector General (OIG) for the U.S. Department of Health and Human Services, Medicaid rebates were three times greater than the discounts negotiated by Part D for 100 brand name drugs. In 68 of these drugs, Medicaid rebates were twice as high as rebates granted by the drug companies for Medicare drugs (OIG HHS, 2011; Hulsey, 2013). Similarly, a 2008 study of drug pricing information by the U.S. House Committee on Oversight and Government Reform found that Part D paid, on average, 30 percent more for drugs than Medicaid (Hulsey, 2013).

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http://www.ncpssm.org/PublicPolicy/Medicare/Documents/ArticleID/1138/Issue-Brief-Medicare-Drug-Negotiation-and-Rebates


The ACA increased the Medicaid rebate percentage.
http://www.medicaid.gov/AffordableCareAct/Timeline/Timeline.html

Medicaid Drug Rebate Program

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The Medicaid Drug Rebate Program is a partnership between CMS, State Medicaid Agencies, and participating drug manufacturers that helps to offset the Federal and State costs of most outpatient prescription drugs dispensed to Medicaid patients. Approximately 600 drug manufacturers currently participate in this program. All fifty States and the District of Columbia cover prescription drugs under the Medicaid Drug Rebate Program, which is authorized by Section 1927 of the Social Security Act.

The program requires a drug manufacturer to enter into, and have in effect, a national rebate agreement with the Secretary of the Department of Health and Human Services (HHS) in exchange for State Medicaid coverage of most of the manufacturer’s drugs. When a manufacturers markets a new drug and electronically lists it with the FDA, they must also submit the drug to the Drug Data Reporting (DDR) system. This ensures that states are aware of the newly marketed drug. In addition, Section II(g) of the Rebate Agreement explains that labelers are responsible for notifying states of a new drug’s coverage. Labelers are required to report all covered outpatient drugs under their labeler code to the Medicaid Drug Rebate Program. They may not be selective in reporting their NDC's to the program. Manufacturers are then responsible for paying a rebate on those drugs each time that they are dispensed to Medicaid patients. These rebates are paid by drug manufacturers on a quarterly basis and are shared between the States and the Federal government to offset the overall cost of prescription drugs under the Medicaid Program.

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Prescription-Drugs/Medicaid-Drug-Rebate-Program.html

The reality is the massive expansion of Medicaid, a single payer system, along with the option for states to replace their exchanges with a single payer system will speed the arrival of single payer in this country.

When Vermont's system is up and running, I expect the dominoes to fall, finally.

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Response to ProSense (Reply #12)

Mon Mar 31, 2014, 07:37 PM

15. All great news for now and excellent chance for our future

in Health Care in our country.

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Response to Cha (Reply #15)

Mon Mar 31, 2014, 11:10 PM

16. Yup. n/t

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Response to ProSense (Reply #16)

Mon Mar 31, 2014, 11:35 PM

17. John Legend Tweets..

John Legend ✔ @johnlegend
Follow
if you think you're hurting Obama by not getting health insurance, trust me, he'll be fine either way.
9:35 AM - 31 Mar 2014
1,164 Retweets 1,426 favorites
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John Legend ✔ @johnlegend
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It's amazing that anyone would actively discourage people from signing up for health insurance. Hope you pay for their medical bills too.
8:59 AM - 31 Mar 2014
727 Retweets 834 favorites
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Favorite

MOre Tweets..
TOD

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Response to Cha (Reply #17)

Tue Apr 1, 2014, 09:59 PM

18. YouTube Stars Talk Health Care at the White House (March 6)

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Response to ProSense (Reply #18)

Tue Apr 1, 2014, 10:04 PM

19. I saw that, PS.. in fact I posted it in the Dreaded

BOG around that time.

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