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Guest column | Marc Yacht

Health care reform has been opposed for decades

At the close of World War II, President Harry Truman proposed a new national health care program. The president witnessed Great Britain's support of its universal health care while broke and rebuilding from the war's rubble. Truman said, "The health of the American children, like their education, should be recognized as a definite public responsibility."

The president's plan recognized the lack of physicians, nurses and hospitals in rural areas. He suggested monetary supplements to physicians, making their practices viable, and aid for doctor recruitment in poor communities. Truman recommended federal dollars for hospital construction. He further designed an oversight board. Most controversial was his proposed national health insurance plan. His proposals came before Congress in the form of a Social Security expansion bill.

The American Medical Association attacked the bill characterizing it as socialized medicine. These attacks gained traction at a time of heightening anti-communist fervor. Add the start of the Korean conflict and President Truman abandoned his health care effort. It is an interesting footnote that President Lyndon Johnson signed Medicare into law in 1965 at the Harry S. Truman library saying this effort, "… all started really with the man from Independence [ Harry Truman ]."

As for Johnson's successful effort, the American Medical Association was firmly against the Medicare program. Then AMA President Dr. Edward Annis broke down in tears on national television railing against Medicare. That was the same Edward Annis who argued that smoking warning labels were unnecessary.

President Richard M. Nixon picked up the banner for health care reform claiming, "Let us act now to assure all Americans financial access to high quality health care." He further argued, "For the average American family, it is clear that without adequate insurance, even normal care can be a financial burden while catastrophic illness can mean catastrophic debt." The year was 1974.

Among elements of his plan were employer mandates and HMOs. Hawaii adopted the Nixon model and became the first and only state to accomplish universal health coverage. Congress quickly moved to thwart such employer mandates outside of Hawaii. Nixon's national plan never materialized, derailed by the Watergate scandals and his resignation.

The Clinton health care proposal, 1,000 pages long, required every U.S. citizen and permanent resident alien to be enrolled in a qualified health plan. In 1993, 37 million Americans were uninsured; currently the numbers are approaching 50 million. Again, complex forces including many medical associations, conservative policy groups and concentrated media blitzes, undermined the effort. Among the more interesting arguments were those suggesting that no health care crisis existed.

The current picture of a dysfunctional health care system leaves tens of millions uninsured, millions more underinsured, and many insured unhappy. It was further suggested that as many as 1 in 3 Americans under the age of 65 were uninsured for as long as six months during 2007. That could push the numbers as high as 87.5 million.

Available health care coverage is unaffordable to many. It bears administrative costs of 40 percent, is fragmented and leaves patients, doctors, hospitals and other providers beleaguered. A simple fix like "Medicare for all" languishes in committee (HR 676) and a 1,000-page document HR 3200 faces fire for its complexity and cost from Democrats and Republicans alike. At risk is another failed effort for needed health care reform and universal health coverage.

There are key elements in HR 3200 that make sense. The most interesting is the creation of a public option for insurance. It is highly unlikely that profiteering private insurers could compete, so they are pulling out all stops to defeat the potential bill. Much to my surprise the American Medical Association is on board with Obama's health care reform. They along with other state medical associations are critical to the potential success of the effort.

As the cost of the plan is bandied about, it is important to consider what would be saved by a universal health plan. A recent letter from the Congressional Budget Office suggests an increase in federal revenues over a 10-year period based on recommended tax changes to the wealthy, stabilizing health care costs by reducing uninsured populations and cutting administrative costs. Medicare administrative costs are less than 5 percent.

Another key element is the establishment of a mandate for health insurance, effective regulation of the health insurance industry, tax credits to employers who insure their employees, and penalties to those who should insure, but don't. It is suggested that the uninsured ranks would be decreased by 37 million non-elderly residents. That translates to families. Oversight would be provided by the Secretary of Health and Human Services.

There is much more embedded in the design to offer health care coverage to millions of Americans and benefit health care providers. The dangers of inefficient health care delivery were recognized by Harry Truman in 1945. His aim of a national health plan assuring that all Americans could be assured of paid health care expenses is more critical now than ever. In 1945, 15 million were uninsured.

Dr. Marc J. Yacht of Hudson is retired director of the Pasco Health Department

Health care reform has been opposed for decades 08/01/09 [Last modified: Saturday, August 1, 2009 1:25pm]
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