The debate on health reform is not new and I have been reading a lot on the historical context trying to see if any meaningful lessons can be culled from past experience. President Richard Nixon and Senator Edward Kennedy battled over healthcare reform, and a compromise was never reached. Steven Pearlstein said in the Washington Post:
"Asked about his greatest regret as a legislator, Ted Kennedy would usually cite his refusal to cut a deal with Richard Nixon on health care.
. . . [in 1971], Nixon asked Congress to require for the first time that all companies provide a health plan for their employees, with federal subsidies for low-income workers. Nixon was particularly intrigued by a new idea called health maintenance organizations, which held the promise of providing high-quality care at lower prices by relying on salaried physicians to manage and coordinate patient care.
At first, Kennedy rejected Nixon's proposal as nothing more than a bonanza for the insurance industry that would create a two-class system of health care in America. But after Nixon won reelection, Kennedy began a series of secret negotiations with the White House that almost led to a public agreement. In the end, Nixon backed out after receiving pressure from small-business owners and the American Medical Association. And Kennedy himself decided to back off after receiving heavy pressure from labor leaders, who urged him to hold out for a single-payer system once Democrats recaptured the White House in the wake of the Watergate scandal.
Thirty-five year later, the single-payer dream of Democratic liberals still remains politically out of reach . . .
The simple lesson from this story -- and certainly the one Kennedy himself drew -- is that when it comes to historic breakthroughs in social policy, make the best deal you can get, leaving it to subsequent generations to perfect."
I believe that at the time they thought that since President Nixon was embroiled in the Watergate scandal, the next President could win the day. But President Jimmy Carter did not make healthcare reform a priority, and so Kennedy later regretted rejecting Nixon’s proposal.
Check out this video on the health reform debate in 1970's:
President Nixon addressed the Congress to urge passage of the Comprehensive Health Insurance Act. Nixon's proposal was extensive and designed to improve protection against catastrophic illnesses. To ensure access to all, Nixon's plan would grant government subsidies to small businesses and the self-employed while building on existing employer-sponsored programs. You can read President Richard Nixon in his own words...
Radio Address About a Proposed Comprehensive Health Insurance Plan May 20, 1974
This week, the Senate Finance Committee will begin hearings on health insurance legislation that could usher in a historic reform of the American health care system. I am gratified to see that serious action on this most vital matter is going forward on both sides of the Capitol, and I am confident that the executive and legislative branches of the Government, in a spirit of statesmanship and compromise, can work together to resolve the problems of providing health insurance legislation which meets the needs of all Americans.
While Americans today enjoy the finest health care and medical technology in our history, the cost of that care is constantly increasing. Our present system of health care insurance does not meet the costs of providing adequate care. It must be improved.
Twenty-five million Americans have no health care insurance at all, and millions of others have inadequate protection.
Less than half of those under 65 years of age have protection against catastrophic health costs, and almost no one over 65 has such protection.
Preventive services, mental health care, outpatient services, and medication are often excluded from coverage. Many other essential services are not adequately covered.
And finally, to further burden our already inadequate health insurance system, wage-price controls have expired, and there is no brake on further increases in health costs. The failure of the Congress to adopt my legislative request to continue authority for mandatory cost controls for the health industry has left the country unprotected against the very real possibility of an unbridled increase in those costs.
A few facts and figures will give you an idea of the scope of the problem.
In the past 2 3/4 years, the overall cost of health care has risen by more than 20 percent.
The national average cost for a day of hospital care now exceeds $ 110. It costs an average of close to $1,000 to cover delivery of a baby and postnatal care. The average cost of health care for terminal cancer now exceeds $20,000 per person.
And now, in the absence of controls, the country faces a possible annual increase of 22 percent in physicians' fees alone.
To emphasize the Government's concern over skyrocketing health costs, Secretary Weinberger, of the Department of Health, Education, and Welfare, met with representatives of 20 of the Nation's major health provider groups on May 3. He urged them to take every action at their disposal to prevent the rapid escalation of costs and indicated that if cost increases were not voluntarily controlled, it could lead to drastic, congressionally imposed, mandatory controls. I strongly share Secretary Weinberger's concern on this matter, and I urge the health industry to do everything it can voluntarily to keep the brake on rising health care costs.
But voluntary restraints will not be enough. We must have legislation to insure that every American has financial access to high quality health care.
Nineteen seventy-four can and should be the year in which we move decisively to protect every American against the rising and often prohibitive costs of health care.
Nineteen seventy-four can and should be the year in which we create new incentives to make the health care system of the United States even better and more efficient than it is.
And 1974 can and should be the year in which firm, fair steps are taken to hold down the rate of inflation that has continually driven the cost of medical care higher and higher during the past 20 years.
Never has the need been greater, or the national climate more favorable, for the development of a sound consensus on a comprehensive program of health insurance than that need is today.
In order to best serve the American people, such a program must include three basic principles:
--It must maintain the patient's freedom to choose his own physician.
--It must build on the capacity and diversity of our existing private system of health care, rather than to tear it down and seek to erect a costly, federally dominated structure in its place.
--And it must provide all parties-consumers, providers, carriers, and State governments--with a direct stake in making the health care system work.
The comprehensive health insurance plan which I have proposed meets these criteria. It is the only one of the major proposals now before Congress which does SO.
It is the only major plan that offers extensive, uniform health coverage without raising your taxes, without severely damaging the effective private health insurance industry that has helped to make this generation of Americans the healthiest, best cared-for in our history, and without establishing an enormous new Federal bureaucracy.
Most important of all, under the comprehensive health insurance plan, your doctor would continue to work for you, and not for the Federal Government. These basic principles must not be sacrificed or compromised.
While I believe the plan I have submitted is sound in its basic objectives, we are not ruling out compromise where compromise does not violate the basic principles of our proposals which I have described. I welcome the development of the new plan sponsored by Senator Kennedy and Congressman Mills which includes many of the same features as the Administration proposal. I also believe that the proposal sponsored by Senators Long and Ribicoff focuses well deserved attention on the problem of catastrophic illnesses. Members of the House and Senate have made constructive proposals which deserve consideration in other areas. However, major differences remain.
The Kennedy-Mills proposal would be administered almost totally by the Federal Government, and it would be paid for by increasing your Federal payroll taxes. It would be a compulsory plan, forcing the participation of those who do not need or who do not want coverage, as well as those who do.
The Long-Ribicoff alternative proposal would also be directly administered by the Federal Government, but in most cases, it would only offer coverage for catastrophic illnesses and leave participants unprotected against many other substantial health costs which are covered by the comprehensive health insurance plan which I have proposed.
The Administration plan would offer every American broad and balanced health protection through one of three major programs:
--The employee health insurance would cover most Americans and be available through their jobs. The cost would be shared by employers and employees on a fair basis.
--An improved Medicare plan would cover those 65 and over and would include additional medical costs and benefits not included under the current Medicare system.
--The assisted health insurance plan would cover low-income Americans and persons who would be ineligible for the other two programs, with the Federal and State governments paying those costs which are beyond the means of the individual insured.
The medical care offered by these three plans would be identical for all Americans regardless of age or income. Benefits would be provided for hospital care, physicians' care in and out of the hospital, prescription and lifesaving drugs, laboratory tests and X-rays, medical devices, ambulance services, and many other forms of health care.
There would be no exclusions from coverage based on the nature of the illness. A person with heart disease, for example, would qualify for benefits just as would a person with kidney disease.
In addition, the comprehensive health insurance plan would cover treatment for mental illness, alcoholism, and drug addiction, in or out of the hospital.
Certain nursing home services and other convalescent services would also be included. Home health services, for instance, would be covered so that long and costly stays in nursing homes could be averted when possible.
To no group is proper health care more important than to our children. Many conditions, if detected in childhood, can be prevented from causing lifelong disability and learning handicaps. For this reason, children receive special attention under the comprehensive health insurance plan. Services for children would include preventive care up to the age of 6 and would provide for eye examinations, hearing examinations, and regular dental care up to age 13.
There has been a great deal of debate in recent years about health insurance legislation. And there are, naturally, divergent points of view on the question of how to provide the highest possible quality of health care for all Americans. Some believe that we should socialize our system of health care. Now, this might make health care available to all, but it would diminish the quality of care available. It would destroy the incentive for excellence which motivates those who provide our health care. There are others who believe we should do nothing. This would mean that fewer and fewer Americans would have access to the kind of care which we are capable of providing.
Neither course of action, or inaction, is acceptable. What we must have is a creative relationship between government and our private health care system which provides the best possible care for all at a price that all can afford.
Sometimes the best way to measure what we can accomplish in the future is to look at what we have achieved in the past. A generation ago, polio was a deadly, crippling disease, striking down rich and poor alike. The man who served longest as President of the United States spent most of his adult life as a cripple because, at that time, there was no known way to prevent or cure polio.
In my own family, two of my brothers, one older, one younger, died of tuberculosis because, in the 1920's and 1930's, tuberculosis was still an uncontrolled killer disease.
Today, both of these once dreaded diseases are no longer a threat to the American people. In the same way, if we work together--the people, the President, and the Congress--we can apply the genius of the American system while working with other nations as well in finding cures for other dreaded diseases such as cancer and heart diseases. Equally important, we can make the best possible medical care available to all of our citizens, young and old, rich and poor.
The comprehensive health insurance plan which I have proposed can accomplish this. I hope that the Congress will continue to move promptly on this program, so that in the future, we will be able to look back on 1974 as the year in which America, long the wealthiest nation in the world, acted decisively to become the healthiest nation as well. Thank you and good afternoon.
-------------------------------------------------------------------------------- Note: The President spoke at 12:07 p.m. from Key Biscayne, Fla. His address was broadcast live on nationwide radio. An advance text of his address was released on the same day.
-------------------------------------------------------------------------------- Citation: John T. Woolley and Gerhard Peters,The American Presidency Project [online]. Santa Barbara, CA: University of California (hosted), Gerhard Peters (database). Available from World Wide Web: http://www.presidency.ucsb.edu/ws/?pid=4215.