It would appear that President Obama’s determination to hold a healthy national debate about the reform of our health care system has fallen victim to the same sort of rhetorical excess that plagued health reform advocates in FDR’s day. With some opponents accusing the Administration of trying to establish a “socialist state” and others equating the Administration’s quest for reform to an attempt to pursue “Nazis policies,” the much needed conversation about what role the government should play in insuring the health of its citizens has largely dissipated into an incoherent shouting match. This is unfortunate. If it continues, it may threaten the ability of Congress and the Administration to bring about meaningful reform—or worse—it may kill the effort entirely.
Evidence for this can be found in the ill-fated attempts to push health reform through Congress during the height of the New Deal, when, according to FDR’s trusted confidant, Harry Hopkins, some form of comprehensive health insurance had perhaps the best chance of passage it would ever have. In 1935, there was serious discussion within the Roosevelt Administration, spearheaded by FDR’s Committee on Economic Security—about whether or not to include a health insurance provision within the legislation that established Social Security. Due to the vehement opposition of the America Medical Association (AMA) and other bodies, as well as the widespread fear among Administration officials that including health care in the legislation would kill the entire Social Security effort—the health care provision was dropped.
In 1939 health care reform once again became a possibility when Senator Robert Wagner introduced a bill that was inspired in part by FDR’s Technical Committee on Medical Care—a body which issued a report in 1938 that among other things called for an expansion public health services through Federal grants-in-aid to states for “medically needy persons.” In spite of its rather limited scope, opposition to Wagner’s national health bill among the medical establishment was equally strong and with the onset of the war in Europe in September his efforts came to a swift halt.
Undaunted, Senator Wagner took up the cause once more in 1943 with the Wagner-Murray-Dingell bill. This act called for a “single unified system of national social insurance” that would be administered by the states and combine traditional employment security provisions with health insurance, paid for by a payroll tax on employers and employees.
As noted in Phillip J. Funigiello’s excellent book Chronic Politics: Health Care Security from FDR to George W. Bush, the Wagner-Murray-Dingell bill marked the start of a political debate over health care reform that continues to this day. The differences between its proponents—health care reformers, organized labor, the National Farmers Union, the “medical New Dealers”—and its opponents—the AMA, the insurance companies, the Pharmaceutical Manufacturers Association, the American Hospital Association, the American Bar Association and others—were sharp and deep. Moreover, while those in favor of reform remained somewhat divided over some of the details of its execution, the principle weapons of its opponents were not nearly so complex—in short, they boiled down to rhetoric and money.
The Insurance Economic Society of America, for example, characterized government involvement in health insurance as “an issue of human rights versus state slavery;” other called it “un-American” and a threat to the system of free enterprise. Leading figures within the AMA accused the government of trying to establish socialism in America and huge sums of money were expended by the AMA and other powerful groups to drive home these points.
The net effect of these accusations was to make it impossible for the country to engage in a rational political discussion not only about health care, but also about the fundamental nature of our society and the role of government in a liberal, capitalist democracy. As a consequence, six decades later the United States remains the only major industrialized nation without a comprehensive national health care system and over 40 million Americans currently go uninsured.
Meanwhile the charges that were leveled in FDR’s day have come back to haunt us with a vengeance—amplified by a media shamelessly hungry for sensationalized “news.” Sadly, we seem to live in a world where the extreme has become mainstream; where empty rhetoric has replaced rational debate; where our politicians are more interested in appealing to their “base” than in exercising leadership. History, it appears, is tragically repeating itself, much to the detriment of the health of the American people.
David Woolner is a Senior Fellow and Hyde Park Resident Historian for the Roosevelt Institute.