Source: Karen S. Palmer MPH, MS, Physicians for a National Health Program (PNHP)

Brief Summary

  • US circa 1883-1912
    • Matters left in hands of States, which in turn, left them in hands of private industry and voluntary programs
    • Lacked critical mass to make it into the national agenda
  • AALL Bill, 1915
    • In 1906, the American Association of Labor Legislation (AALL) led the campaign for health insurance.
    • Coverage. The Bill limited coverage to the working class and all others that earned less than $1200 a year, including dependents. The services of physicians, nurses, and hospitals were included, as was sick pay, maternity benefits, and a death benefit of fifty dollars to pay for funeral expenses.
    • Costs. Costs were to be shared between workers, employers, and the state.
    • Reception
      • AMA’s Position. In 1917, the AMA House of Delegates favored compulsory health insurance as proposed by the AALL, but many state medical societies opposed it. Due to disagreements on physician compensation, AMA withdrew its support.
      • AFL’s Opposition. President of the American Federation of Labor repeatedly denounced compulsory health insurance – to maintain union strength.
      • Private Insurance Industry’s Opposition. Bill’s coverage for funeral expenses would undermine the multi-million dollar life insurance industry’s existing business (coverage for funeral expenses).
  • WWI and anti-German fever, circa 1917
    • Compulsory national health debate tabled until 1930’s
  • The Committee on the Cost of Medical Care (CMCC), 1920’s
    • Self-created & privately funded by 8 philanthropic organizations including the Rockefeller, Millbank, and Rosenwald foundations to address concerns over the cost and distribution of medical care.
    • Position. CCMC recommended that more national resources go to medical care and saw voluntary, not compulsory, health insurance as a means to covering these costs.
    • Reception. AMA treated CMCC’s documents as a radical position advocating for socialized medicine.
  • FDR’s Attempts at Universal Health Care Provisions
    • First Attempt – Social Security Bill of 1935
      • Compulsory health coverage provisions were excluded from the Bill due to fierce opposition from the AMA.
    • Second Attempt – Wagner Bill, National Health Act of 1939
      • Never enacted due to unfavorable political environment.
  • Wagner-Murray-Dingell Bills: 1943 and onward through the decade
    • Aims to establish compulsory national health insurance funded by payroll taxes
    • Never passed, but generated extensive national debates
  • Truman Period, 1945
    • Truman was strongly committed to a single universal comprehensive health insurance plan.
    • Reception. AMA, the American Hospital Association, the American Bar Association, and most of then nation’s press hated the proposed plan.
    • Resistance. In 1945, the AMA spent $1.5 million on lobbying efforts which at the time was the most expensive lobbying effort in American history.
    • Outcome. Truman’s plan died in congressional committee.
    • Causes for Failure. Interest group influence, ideological differences, anti-communism, anti-socialism, fragmentation of public policy, the entrepreneurial character of American medicine, a tradition of American voluntarism, removing the middle class from the coalition of advocates for change through the alternative of Blue Cross private insurance plans, and the association of public programs with charity, dependence, personal failure and the almshouses of years gone by.
  • Johnson and Medicare/caid – Victory(?) at Last!
    • Rhode Island congressman Aime Forand introduced a new proposal in 1958 to cover hospital costs for the aged on social security.
    • The AMA countered by introducing an “eldercare plan,” which was voluntary insurance with broader benefits and physician services.
    • Concessions were made:
      • to the doctors (reimbursements of their customary, reasonable, and prevailing fees)
      • to the hospitals (cost plus reimbursement)
      • to the Republicans created a 3-part plan, including:
        • the Democratic proposal for comprehensive health insurance (“Part A”)
        • the revised Republican program of government subsidized voluntary physician insurance (“Part B”)
        • Medicaid
    • Finally, in 1965, Johnson signed it into law as part of his Great Society Legislation, capping 20 years of congressional debate.
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