Healthcare

ALTHOUGH HEALTHCARE HAS always been a major social issue, it is considered to have first become a major political issue in the mid-1940s. As World War II came to a close and the American public concentrated on domestic issues, one growing concern was that citizens in the middle-income bracket were struggling to access adequate healthcare. In order to raise the issue to priority status, President Harry S. Truman recommended a national healthcare program during a special address to the U.S. Congress on November 19, 1945. While Truman's message marked the first time a sitting president publicly endorsed a national healthcare program, healthcare has actually been a long-standing issue with complex roots and numerous interests that have combined to make it an inescapable political issue.

Healthcare as an issue has focused on the question of whether—or to what extent—it is the responsibility of government to subsidize healthcare for its citizens. While Thomas Paine had earlier written about it, the subject first substantively appeared on political agendas in 1854, when President Franklin Pierce vetoed a national mental health bill on the basis that it would be unconstitutional to regard health as anything but a private matter in which government should not [Page 298]become involved. At the time, most Americans agreed. Private charities and groups, community authorities, and religious institutions were left to provide services for the sick, elderly, and poor whose families could not assume their health needs. This trend largely continued for the next several decades, but gradually shifted as the United States became more industrialized and urbanized. By the early 20th century, conservative and liberal political agendas, legislative debates, and campaign platforms included stances on healthcare. Conservatives tended to call for limited government oversight of healthcare, while liberals appealed for some form of government-funded health insurance.

Congress signed Medicare into law on July 30, 1965. It has since become a popular, though controversial entitlement.

At the same time, informed readers and intellectuals had begun to read about, and give praise to, the models of tax-supported health insurance programs that cropped up all over Europe. Among this crowd was a small cohort led by social-workers who lobbied for industrial-sickness insurance that could protect laborers' financial well being in the event of workplace accidents. In the run-up to the 1912 presidential election, such a group of health reform advocates had become a coordinated movement. They chose to support the Progressive nominee, Theodore Roosevelt. Roosevelt, the health reform advocates believed, would better advance their cause than would Democratic nominee Woodrow Wilson, Socialist nominee Eugene V. Debs, or Republican nominee William H. Taft. Wilson won the election and, once elected, acted quickly on a number of the domestic reforms that shaped his liberal platform. Health insurance, however, was not a priority, especially with attention increasingly diverted to foreign affairs and World War I.

In the post-war era, as the country organized under the concentration of new social influences, interest in the health insurance debate waned. But the prosperity and hope that ushered in the 1920s was met by economic depression at the end of the decade. This downturn was blamed on President Herbert Hoover, a Republican, and in the 1932 election, Democratic nominee Franklin Delano Roosevelt defeated him. The election of Roosevelt and his New Deal program included the creation of Social Security, which once again brought to the fore the issue of governmental health insurance. Throughout the years of his administration, Roosevelt and his advisors—several of whom were from the social work and medical communities—balanced the politically delicate issue of health insurance. During his first term, Roosevelt favored a national health insurance program as part of the Social Security Act, but deferred the plan when he detected that special interest opposition to it would likely jeopardize passage of the entire act. By the end of his administration, and despite the onset of World War II, Roosevelt managed to organize and publicize health reform so that it could be elevated to a more contentious political issue.

...