Monday, March 9, 2009

Can Obama take the deja out of vu?

The current issue of Roll Call has a fascinating interactive timeline on legislative efforts in the United States to enact a national health insurance plan. The timeline goes all the way back to 1883, when German Chancellor Otto von Bismarck created the world's first national health insurance program.

The U.S. misadventure starts in 1915 (coincidentally, the same year that ACP was founded) when the "American Association for Labor Legislation proposes a 'model bill'" for compulsory national health insurance---with initial support from the American Medical Association! (As we all know, within a few years the AMA had switched to oppose any kind of national health insurance plan.)

Click on any of the highlighted dates, and a window will open with more information on what happened (or more often did not happen) that year.

The tool is a lot of fun for armchair health historians like me. Except for the four dreaded words that show up throughout the timeline:

"Congress rejects the plan."

1939: "Sens. Robert Wagner (D-N.Y.), James Murray (D-Mont.) and Rep. John Dingell Sr. (D-Mich.) introduce a national health bill in February. After hearings from April to July, the measure dies in committee."

1946: "The Wagner-Murray-Dingell measure is reintroduced. During April hearings before the Senate Education and Labor Committee, the sponsors carefully avoid the word 'compulsory' when discussing the legislation. Sens. Robert Taft (Ohio) and Joseph Ball (Minn.) and Rep. Margaret Chase Smith (Maine) offer a Republican alternative that provides grants to the states for medical care to the poor. The debate is repeated again in 1947 and 1949."

1974: "President Richard Nixon propose[d] a Comprehensive Health Insurance Act after calling for universal access to health insurance in his last State of the Union address. The plan builds on existing private employer-based health insurance, adding subsidies for the self-employed and small businesses. Congress rejects the plan."

1979: "Congress rejects Carter plan."

1994: Majority Leader George Mitchell abandons Senate reform efforts, marking the end of the Clintons' Health Security Act. Republicans take control of Congress in the November elections for the first time in 40 years.

Fast forward now to March 5, 2009. President Obama tells the VIPs at last week's White House summit:

"Health care reform cannot wait, it must not wait, and it will not wait another year."

If Obama is right, he will achieve something that eluded FDR, Truman, Kennedy, Johnson, Nixon, Carter, and Clinton.

Like Captain Kirk from the old Star Trek series, Obama must be so supremely confident in his abilities that he believes he can go where no president has gone before. Or he understands that something has fundamentally changed in the United States that makes the conditions for reform more favorable than at any time since Bismarck. Or maybe it is both.

Today's questions: Why do you think President Obama believes he will succeed when the history of health care reform in the U.S. is really a story of how "Congress rejects the plan" over and over again?


Steve Lucas said...

For many years health insurance was a given, have a job, then you had insurance. In the last couple of decades health insurance has grown as a personal cost item for most households with it now becoming the major expense for many families.

The growth of the internet along with increasing educational levels in this country have allowed other countries health insurance models to become well known, along with their cost structure.

The result has been the growing awareness that there is a better way. Our older population remembers a time when medicine was not a profit making enterprise. Younger people are watching parents and grandparents being treated for terminal illnesses, at great expense, with the only result being extending their suffering.

As in most cases with group frustration people turn to the government for answers. While I am not a fan of government involvement in any activity the simple reality is the medical community has so abused the patient population government action is the only reasonable way to achieve some level of sanity.

There will be rules and paperwork and on and on in an effort to stem the rising tide of cost and waste. The greatest loss will be the relationship of patients with those really great doctors who have stayed the course, and offered caring cost effective services to their patients.

Steve Lucas

Jay Larson MD said...

The moon is in the Seventh House
and Jupiter aligns with Mars. This is the dawning of the Age of Aquarius. Harmony and understanding. Sympathy and trust abounding. No more falsehoods or derisions. Golden living dreams of visions. Mystic crystal revelation
And the mind's true liberation
Aquarius! Aquarius!

Yes, President Obama feels that the planets are aligned for health care reform. With all that is going on, though, he probably wishes that Scotty would beam him up.