Dr. Tom: A Brief History of the U.S. Government and Healthcare, Part II …

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While everyone would agree that the passage of Medicare in 1965 was a landmark event in not only American healthcare but also American politics, the failure to include Americans of all ages created a hole that many have tried to fill while others have tried to dig deeper. The lack of the political will or the political capital to pass Medicare-for-All has been a constant companion to all discussions of healthcare policy over the past 50-plus years.

But, building on the perceived success of Medicare and Medicaid in providing healthcare to the elderly and poor, forces aligned to push for better coverage for everyone. Thus, President Nixon (1968-74) proposed an employer mandate to provide insurance and didn’t want anyone to be denied basic medical care by the inability to pay, but didn’t want to compel Americans to have insurance. He wanted to increase funding to medical schools to train more doctors and add incentives to increase preventive care, and proposed $100 million to cure cancer. Sound familiar?

Although rhetoric continued, the next major push to reform healthcare came during the Clinton presidency (1993-2001), and we all know how that faired. Lobbyists funded by doctors had stopped reforms under President Truman in 1945 and lobbyists funded by insurance companies stopped them here. The TV commercials featuring Harry and Louise, sitting at their kitchen table lamenting the loss of their good insurance policy because of government interference, helped to kill the Clinton plan.

Some things were accomplished in the meantime, however. The Emergency Medical Treatment and Active Labor Act of 1986 prevented “patient dumping” by hospitals and required all hospitals to provide emergency care to anyone who needed it, regardless of citizenship, legal status or the ability to pay, in effect mandating “universal care,” though not providing for a way to pay for it.

The Medicare Prescription Drug, Improvement, and Modernization Act, passed in 2003, created Part D Medicare to help cover drug costs but also specifically prevented Medicare from negotiating drug prices. Governor Romney signed a bill in Massachusetts in 2006 based on three principles: coverage of all, regardless of health status; an individual mandate; and subsidies to cover the cost of insurance for low-income individuals.

Welcome to 2010 and the Affordable Care Act, also known as Obamacare. The machinations that created this law are reminiscent of sausage making — best to avoid viewing it if you want to eat the sausage — and are thoroughly discussed in Steven Brill’s eye-opening book “America’s Bitter Pill.” Suffice it to say that the act was created by and for health-insurance companies.

Nevertheless, it has had many positive consequences that should not be overlooked. One specific issue I found interesting was President Obama’s statement that “If you like your present insurance policy you can keep it,” showing not, I believe, subterfuge, but ignorance of how poor many insurance policies really were.

Despite the protestations of Harry and Louise 20 years earlier, it can be said, with only a minimal infusion of irony, that the only people who like their health-insurance policies are those who have never had to use them.

Next time: Who is getting wealthy from healthcare?

Dr. Kluzak, an Idyllwild resident, is board certified in Anatomic Pathology, Obstetrics and Gynecology. He also is a freelance photographer for the Town Crier.

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