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| Anita...thinking... |
It wasn't until my brother's schoolmate David died at eight or nine with leukemia that I began to understand what my parents were saying. And what of my parents themselves? They were horribly scarred by sickness. They lost their mothers to common infections in the 1920's when they were both only four years old. They remembered seeing the pine coffins set out in their living rooms, the mirrors covered. My mother and father, later to be drawn together by their shared losses, were both nurtured by their aunts.
Serious illness, therefore, was a part of life to be carefully guarded against. Being able to obtain the best healthcare for their family and for themselves became vitally important. And how to pay for it? Insurance, of course.
The first individual illness and disability policies were issued in Boston in 1847. The first major health insurance plans in the U.S. started during the Civil War to cover costs caused by rail or steamboat accidents. In Europe the focus was broader. Compulsory national "sickness insurance" to protect against lost wages was introduced in Germany in 1883, and then in Austria, Norway, Britain, Russia, and the Netherlands by 1912.
But efforts to provide comprehensive insurance to stabilize income in the setting of illness in the U.S. repeatedly failed due to opposition from physicians, labor unions, and insurance companies. By the late 1920's medical costs became more important than loss of wages as more middle-class individuals used hospitals, and paying for healthcare itself was now the issue.
In 1929 the first group insurance plan in the U.S. was formed as teachers in Dallas contracted with Baylor Hospital for room, board, and medical services in exchange for a monthly fee. The non-profit Blues began in 1932 and in 1930's and 1940's the large for-profit life insurance companies entered the health field. This was followed by tax-preferred employer-sponsored plans in the 1940's. Strong unions bargained for better benefit packages, including tax-free employer-sponsored insurance. Yet, as compared to healthcare systems evolving in Europe many people were still left out.
Franklin D. Roosevelt (FDR) had originally included compulsory health insurance in the Social Security Bill of 1935 but dropped this provision for several reasons, among which was strong opposition from the American Medical Association (AMA) and other prominent stakeholders with large financial interests. There was the claim and fear that this would sever the sacred bond between the doctor and the patient (a bond worth preserving, even now). FDR tried to push legislation (though half-heartedly) again in 1939, but World War II and a conservative backlash intervened, and nothing happened.
The Wagner-Murray-Dingel Bill was introduced in 1943 and called for compulsory national health insurance funded through a payroll tax. It failed then (and each time it was brought before Congress for the next 14 years!). When President Truman once again proposed national healthcare in 1945 and 1949 the AMA conducted the most expensive lobbying effort to that date, spending 1.5 million dollars to defeat the bill. And that was that, for a while.
Amie Forand introduced a bill in 1958 that focused only on the elderly and the AMA resisted again, but this bill hit a nerve and garnered unprecedented support from the people.
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| Johnson taking the Oath of Office |
After the shocking assassination of President Kennedy, as the country was in grief, Lyndon Johnson, while on the plane from Dallas and haven just taken the oath of office, committed to moving forward on JFK's vision of expanding guaranteed healthcare insurance to the elderly and the impoverished (Bill Moyers, on “Fresh Air” 8/3/17).
If my parents' mothers had lived to old age they would have been among the first recipients of Medicare.
(Published in the "York Daily Record" Sunday September 17, 2017)