Why health-care reform gets harder over time
This is a good Slate explainer looking into whether the health-care reforms of the early-20th century actually had a health-care system to reform. The answer, basically, is no, and for reasons I'll explain, that should make us very skeptical of rejecting this latest attempt at reform.
In 1870, there were only 112 hospitals in the United States, probably because doctors couldn't do much to help patients other than hacking off limbs or sedating them with morphine. (Morphine was available over the counter until 1914, anyway.) Hospital patients were mostly poor people who couldn't work and had no one to care for them. The wealthy, meanwhile, paid for home-based care. Even amputations were frequently performed in a patient's home. But starting in the 1890s, hospitals became much more useful. Doctors could treat diphtheria and see inside the body with radiography. Surgeons began working in aseptic operating rooms, enabling them to open the chest cavity and remove diseased organs. In the 1900s, new diagnostic tools like the Wasserman syphilis test became available. Medical schools moved from two-year curricula — with the second largely repeating the first — to four-year, science-based programs that included practice sessions at hospitals. By 1920, there were 6,000 hospitals nationwide.
When the working class began to clamor for access to the new technologies, Roosevelt's Progressives were the first major American party to pick up the baton of health care reform. (Germany had a compulsory health-insurance program since 1883, and the British National Insurance Act passed in 1911.) While the party platform offered a vague endorsement of a socialized insurance system, Progressives pushed a much more specific program in state legislatures in 1915. Participants and their families would be guaranteed all medical and hospitalization expenses, income replacement for up to six months, $50 for funeral expenses, and complete coverage of labor and delivery costs with an eight-week maternity benefit. The plan would cost about $2 per worker, with the expense split between employers ($1.20), workers (40 cents), and the state (40 cents). All workers earning less than $100 per month would be required to participate, and the burden on the employer would increase for particularly low-wage laborers.
Over the past hundred or so years, the health-care system has gone from a very small portion of our economy to about a fifth of it. That's a remarkable rise. And it has been accompanied by a similar rise in the political power of the health-care industry. I've previously argued that the history of health-care reform is a history of decreasing ambition: FDR and Harry Truman propose something like single-payer, John F. Kennedy and Lyndon Johnson ratchet back to single-payer for seniors and poor people, Richard Nixon and Bill Clinton offer national systems that rely on private providers, and now President Obama is building a private system that's initially limited to small businesses and individuals.
There are a lot of reasons for that. One is that political defeat engenders future timidity. But another is that the gaps between proposals give the health-care industry time to grow even larger and more politically powerful, which means that the next president who takes up the issue is faced with a more daunting task and pulls back his ambitions accordingly. If Obama fails this year, then President Chris Hayes, who'll give this a shot in 2030, will be proposing universal health-care for non-avian pets, because who tangles with interests representing 34 percent of the economy?
Photo credit: AP file photo.
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