That old bogeyman Ulysses S. Socialism has arrived again on the usual signal — an approaching election where medical care and social welfare are big issues with voters and politicians. It has been so for more than a century, although memories, as always, are in short supply.
Every feint by old Sam is terrifying, which is why he is always just offstage. Donald Trump counts on him to persuade enough voters that the staid old Democratic Party has suddenly become the agent of Marxism so that Trump can climb back into office next year. It is not likely to happen, but Democrats from Roosevelt and Truman to Obama and a few Republicans, too, have been flummoxed about how to fight the socialist label.
Democratic voters, like the politicians, should understand that socialized medicine has virtually no history in the United States beyond veterans care, and no serious politician proposes it today — not even the self-proclaimed socialist Bernie Sanders. Great Britain adopted socialized medicine in 1911, along with unemployment insurance and a minimum wage. The United States would embrace the minimum wage and unemployment compensation, but no one in government ever proposed that the government adopt David Lloyd George’s plan for the government to become not just the insurer for everyone but also the medical provider.
Sanders and a good half the field of Democratic presidential candidates support the concept of “Medicare for all,” although a few of them also favor other steps, including reinforcing the Affordable Care Act as the path to get to universal insurance. Medicare for all is treated by the media, including the statewide daily, as a radical idea bordering on socialism.
Bernie didn’t come up with Medicare for all. He stole it from Republicans. Sen. Jacob Javits (R-N.Y.), working with Republican Governor Nelson Rockefeller, later the vice president, introduced a Medicare-for-all bill in 1970. The GOP then housed the most liberal quotient of the U.S. Senate and most of them — Clifford Case (R-N.J.), Richard Schweiker (R-Pa.), George Aiken (R-Vt.), Mark Hatfield (R-Ore.), Hiram Fong (R-Hawaii), Caleb Boggs (R-Del.) and Charles Percy (R-Ill.) — joined Javits on health-care reform. No one accused the GOP of veering to the left or of being a tool of Moscow, as they did Harry Truman in the late 1940s for trying to guarantee health care for everyone.
Sen. Edward M. Kennedy soon introduced his own plan for universal coverage in response to Javits, and then, in 1971, President Nixon came out with his own plan, a form of Medicare for all but with lots of working parts: a mandate for employers to provide coverage for workers who would pay 25 percent of the premiums, Medicare reforms, federalization of Medicaid for the poor, and inducements for health-maintenance organizations (HMOs). By 1974, Congress was steaming toward universal coverage — a certainty by year’s end, The New York Times predicted — but Nixon’s resignation ahead of impeachment changed the political dynamics. President Gerald Ford, the former ultraconservative congressman, pleaded with Democratic congressional leaders to take the Nixon plan, fix it to their desires and pass something. For a brief respite, there was little talk of socialism and socialized medicine, beyond the muted warnings of the American Medical Association.
America would have had universal health insurance were it not for two other developments that fateful summer and fall. Owing to the Argentine stripper Fanne Foxe and alcoholism, Congress lost Arkansas’s Rep. Wilbur Mills, who had pulled together liberals and Republicans in 1965 to enact Medicare and Medicaid, and Kennedy and the Democrats decided to wait for the 1976 presidential and congressional elections and a new Democratic majority. Democrats won Congress and the presidency all right, but Kennedy and President Jimmy Carter fought over the lineaments of health-care reform for four years and lost the initiative for another generation.
It was the second greatest Republican, Teddy Roosevelt, leading the Bull Moose rebellion in 1912, who proclaimed that medical care for all was a human right that the Declaration of Independence obliged the government to guarantee. It was an idea advanced by the socialist leader Eugene V. Debs, but Roosevelt declared himself a sworn foe of socialism. His fifth cousin, Franklin, intended to provide medical care for everyone in the Social Security Act, paid for, like Social Security, through employer and worker taxes. But the AMA declared it socialism and gathered allies like the American Bar Association and the Farm Bureau. Roosevelt abandoned the idea in order to get the rudiments of the pension and disability system into law in 1935.
Roosevelt offered a stand-alone universal health-care bill in 1943 but, feeling the pressures of war and the higher taxes that paid for it, he did not press for its enactment. Truman picked up the cudgels in 1946 and spent the rest of his presidency trying to extend quality medical care to everyone, including a plan that could be compared to Bernie Sanders’ Medicare for all, although Truman went much further and proposed exactly how it would be paid for, with employer and employee taxes. The AMA suggested that Cold Warrior Truman was a tool of Joseph Stalin and his plan was “un-American.”
“I put it to you,” Truman raged, “is it un-American to visit the sick, aid the afflicted or comfort the dying? I thought that was simple Christianity.” He took on the socialism charge over and over, explaining what socialism and socialized medicine meant. He was not going to make hospitals, doctors and nurses the institutions and employees of government.
Democrats lost control of Congress after 1946 and then regained it, but Truman could never achieve universal health care. He declared it the greatest regret of his life. When Lyndon Johnson passed Medicare and Medicaid, which were to be the first steps in universal insurance, he had Truman and his wife at the signing ceremony and said the old warrior was the true father of Medicare.
Socialism reared his head again when Bill and Hillary Clinton were on the verge of passing a law that offered subsidized private insurance to everyone but the very poor, who would be covered by Medicaid. The airwaves and mail were saturated with claims by an alarmed couple of actors that the government was going to come between them and their doctor and decide the medical attention they would get. Similar campaigns in 2009 and 2010 in states like Arkansas with vulnerable Democratic members of Congress said Obamacare was going to scrub Medicare benefits for the elderly, insert government bureaucrats into medical decisions and make health care less rather than more affordable. Angry people raged at congressmen at town-hall meetings. Two Democrats in the Arkansas delegation who were ardent supporters of universal insurance voted no on the final roll calls.
That is the history, and the lesson is that Democrats — both voters and candidates — make serious and perhaps fatal miscalculations if they insist on something like “Medicare for all” without frankly including all the taxes and reimbursement caps that will have to be a part of it and bearing the brunt of the anger. Medical providers, including hospitals and physicians, would fight it ferociously because income from medical services would plummet. For the good part of 20 years, Congress has avoided enforcing the reimbursement caps that it ordered. Craven congressmen are going to go even further and slash reimbursement for everyone’s care? It won’t happen and not merely because the powerful insurance industry will be on the other side.
Even if Democrats recapture both houses, there is no chance — zero — that the 2021 Congress will pass such a law. Democrats risk their own defeat, but more seriously the country will squander yet another chance to bring everyone under the protection of life, health and equality that the Declaration of Independence promised.