Universal Health-Care Coverage

The U.S. is the only major industrial nation that doesn't have universal health-care coverage.



The U.S. has flirted with some kind of national health policy six times over the past 100 years, only to see the reform impulse wither each time. For instance, a key plank in Theodore Roosevelt's losing Presidential campaign of 1912 was national health insurance.

President Harry Truman tried again after World War II, but he was thwarted by a
potent combination of political forces, including the vehement opposition of the American Medical Assn., which was determined to defend doctors' incomes against the threat of "socialized" medicine.

John F. Kennedy made health care a major issue in his 1960 campaign. He concentrated on what then was called medical care for the aged. He couldn't get it through Congress.

Lyndon B. Johnson did, but even with his legendary legislative skills and the overwhelming Democratic majorities in Congress after the 1964 elections, it took more than a year of hard, sometimes arm-bending persuasion to get Medicare enacted. It was a hard sell with conservative Democrats, not unlike the problem Obama faces now.

That one major victory for government health insurance was an exception to the pattern of starting each attempt from scratch instead of evolving it from what had gone before. When Johnson signed the Medicare bill in 1965 and gave Truman card No. 1, he traveled to Independence, Missouri, to share "this moment of triumph" with the president who had first proposed it 20 years before.

It provided government health insurance at age 65, tied to Social Security. Broader coverage, which FDR, Truman and Johnson all would have liked to gain, was beyond political reach. Not only for LBJ, but also for Republican Richard M. Nixon, who proposed universal health insurance in 1974, seeking to use employer-based coverage along with federal subsidies so that all Americans would be insured. It was to be done by private insurers, not the government. There was bipartisan support until Watergate intervened.




The political perils of change were dramatized in 1988 after Congress enacted a Medicare overhaul that included prescription drug benefits financed with higher fees on upper-income recipients, who rebelled. They protested, demonstrated and even chased the sponsor, then-Democratic Rep. Dan Rostenkowski to his car. Those changes were repealed the next year.

Prescription drug coverage was added to Medicare in 2003, pushed by President George W. Bush, who claimed it as one of his major achievements in winning re-election. It did not come easily. The administration understated cost estimates by half, and Republican leaders muscled it through the House by one vote. To hold down the cost, they wrote a gap into the coverage.

Most people agree that universal health-insurance coverage is a good thing. The question that rightly troubles everyone is how to pay for it. But it can be paid for, and it makes good economic sense to do so. The issue now is whether our politicians are up to the task of offering health-care benefits to all citizens.


President Barack Obama's campaign to reform health care has been won and all of the citizens of the United States are better for his efforts.