Last July 30 we celebrated the 49th anniversary of Medicare and Medicaid. Readers of this column will recall that it was on that date in 1965 that President Lyndon Baines Johnson formally signed these two programs into law in Independent, Missouri, as former President Harry S. Truman and his faithful wife, Bess, watched proudly. when lbj handed over “give ’em hell harry” and bess the pens he used to affix his signature to the document, the president proclaimed mr. truman as “medicare’s real dad”.
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today marks the reason lbj gave such presidential credit to harry truman.
back in 1945, just seven months after a presidency he inherited from franklin d. Roosevelt — Truman proposed a “universal” national health insurance program. in his remarks to congress, he stated, “millions of our citizens do not now have the full opportunity to achieve and enjoy good health. millions now have no protection or security against the economic effects of the disease. now is the time to act to help them get that opportunity and that protection.”
69 years ago, president truman outlined five fundamental goals of national health.
The first was to address the number and disparity of doctors, nurses, and other health professionals, especially in rural and low-income communities where there were “adequate facilities for the practice of medicine” and “the ability to earn of people in some communities makes it difficult, if not impossible, for the doctors who practice there to make a living.” To begin to correct this problem, Truman wanted the federal government to build modern, quality hospitals across the country, especially where they did not yet exist.
The second problem was the need to develop and strengthen public health services (both to control the spread of infectious diseases and to improve sanitary conditions throughout the country) and maternal and child health care. Regarding the latter, Harry Truman reminded Congress, “The health of America’s children, like their education, must be recognized as an ultimate public responsibility.”
third, it sought to increase the nation’s investment in both medical research and medical education.
The fourth issue addressed the high cost of individual health care. “The main reason people don’t get the care they need,” Truman said, “is that they can’t pay for it individually at the time they need it. this is true not only for people in need. it is also true for a large proportion of people who are normally self-supporting.”
and fifth, he focused on the loss of income that inevitably occurs when serious illness strikes. “The disease,” Truman convincingly explained, “doesn’t just lead to medical bills; it also cuts revenue.
Not surprisingly, President Truman’s proposal to fix issues 4 and 5 with a national health insurance plan was the one that drew the most opposition. Truman proposed that all salaried Americans pay monthly fees or taxes to cover the cost of all medical expenses in the event of illness. the plan also required that a cash balance be paid to policyholders, in the event of injury or illness, to replace lost earnings for those individuals.
His measured and careful description of the plan deserves quoting:
“Under the plan I am suggesting, our people would continue to receive medical and hospital services just as they do now, based on their own voluntary decisions and choices. our doctors and hospitals would continue to deal with the disease with the same professional freedom as they do now. however, there would be this very important difference: whether or not patients get the services they need would not depend on how much they can afford at the time… none of this is really new. Americans are the most insurance-conscious people in the world. They won’t shy away from health insurance because some people have mistakenly called it “socialized medicine.” I repeat, what I am recommending is not socialized medicine. socialized medicine means that all doctors work as government employees. the American people do not want such a system. no such system is proposed here.”
the truman plan quickly became a sens-sponsored social security expansion bill. robert wagner (d-ny) and james murray (d-mt) and rep. John Dingell Sr. (d-me). A version of this bill had been proposed in 1943, when fdr was still president, but he died in committee both from the pressures of the war and from a lack of presidential pressure on congress.
At first, things looked a bit rosy for the revitalized 1945 bill: Democrats still controlled both the House and Senate, and several prominent Americans vociferously supported it. Still, the nation was tired of the war, the high taxes needed to pay for the new fdr deal, and what many Americans perceived as an overly intrusive federal government.
Almost as soon as the revitalized bill was announced, the once-powerful american medical association (ama) seized on the nation’s paranoia about the threat of communism and, despite truman’s claims to the contrary, attacked the bill as “socialized medicine”. ” even more scandalous, the housewife derided the truman administration as “followers of the moscow party line”. During congressional hearings in 1946, the AMA proposed its own plan emphasizing private insurance options, which actually represented a political reversal of its previous position of opposing any third-party members in the provision of health care.
another historical player who entered the fray was senator robert taft (r-oh), who introduced the taft-smith-ball bill, which called for matching grants from states to subsidize private health insurance for the needy . Although the AMA supported this bill, Truman opposed it because he believed it would stop the political progress he had made by guaranteeing all American health insurance.
hearings and politics continued until 1946, but little progress was made. During the 1946 midterm elections, Republicans regained control of both the Senate and the House for the first time since 1929, making the bill a dead issue.
harry truman continued to make health insurance a major issue on his campaign platform in 1948 and specifically criticized the ama for calling his plan “un-American”:
“I’m telling you, is it un-American to visit the sick, help the bereaved, or comfort the dying? I thought it was just Christianity.”
truman misled the pollsters by winning re-election in 1948 and even congress was restored to democratic control that fall. But this political power was no match for the AMA’s redoubled lobbying and publicity efforts, which were backed by more than 1,800 national organizations, including the American Bar Association, the American Legion, and the American Farm Bureau Federation. public support waned, and the bill died quietly (again), as the middle class bought private health insurance plans, unions began to collectively bargain for their members’ health benefits, and the advent of war from Korea.
truman later called the failure to pass a national health insurance program one of the most bitter and troubling disappointments of his presidency. He must have been delighted in 1965 to see Lyndon Johnson enact a health insurance plan for the elderly and needy. However, the nation would have to wait another 45 years before passage of the Affordable Care and Patient Protection Act of 2010, a law that remains in jeopardy after Nov. 7, when the us uu. the supreme court took on another legal challenge to its constitutionality. That said, many would insist that much work remains to be done to make health care affordable and accessible to all Americans.