andrew l. yarrow is a historian of 20th-century America and a former New York Times reporter.
Published February 18, 2021
Who made the following statement concerning one of the most pressing issues facing the new Biden administration?
“The real cost of our present inadequate medical care is not measured merely by doctors’ bills and hospital bills. The real cost to society is in unnecessary human suffering and the yearly loss of hundreds of millions of productive working days.”
Could it be Bernie Sanders? Naw, too wonkish for Bernie. Barack Obama? The new president?
Yes, it’s a trick question — but one with an especially sad answer. This powerful call for universal health care was made three-quarters of a century ago by the most persistent advocate ever to occupy the White House — Harry S. Truman.
President Biden pledged to expand access to health care during the campaign, though it is striking how modest his proposals are compared to ones made in 1945, when the GDP per capita (adjusted for inflation) was less than one-third what it is today. Earlier presidents, from Teddy Roosevelt to Franklin Roosevelt, had proposed government-funded health insurance, but no president before or after Truman offered more far-reaching initiatives or fought more doggedly for them. Indeed, the story of Truman’s advocacy in an era in which Americans expected far less from Washington is depressing testimony to how little we expect from government today in terms of safety and security.
In September 1945, just weeks after World War II ended, Truman told Congress that he would submit a proposal under which “all citizens would be able to get medical and hospital service regardless of ability to pay.” The plan, unveiled two months later, looked a bit like a turbocharged version of health care in today’s Canada. Every wage-earning American would receive comprehensive insurance. Patients could choose their doctors. Physicians would not become government employees, but the government would set reimbursement rates, which would incentivize them to practice in rural and low-income areas. Preventive care would be emphasized. And here’s a big one: money from the funds collected to pay for the system would also be used to replace income lost by individuals when ill or injured.
But this wasn’t all.
Truman appealed to Congress to enact legislation to expand medical schools and provide financial aid to low-income medical students. Next, the federal government should help fund the construction of new hospitals and clinics “in communities where they are needed.” He continued: “We should improve the public health preventive and disease control services, which are now inadequate in most areas and totally lacking in many.”
Gallup found that 59 percent of Americans who were familiar with Truman’s proposal were in favor. Senators Robert Wagner (D-NY) and James Murray (D-Mont.), along with John Dingell Sr. (D-Mich.) in the House, introduced legislation providing for much of what Truman asked for, to be funded with a 3 percent payroll tax up to a relatively high threshold — much like Social Security.
Truman paved the way for President Lyndon Johnson to win approval in 1965 for Medicare and Medicaid — programs that now insure one American in three.
The opposition, led by the American Medical Association (AMA), quickly organized, calling the plan “socialized medicine.” They adroitly played on growing fears of communism, which proved a pretty easy sell: Stalin had already established puppet regimes in occupied East Germany, Romania, Albania and Bulgaria. Moreover, the AMA countered with its own plan, which relied on expanded private insurance and federal aid to fund care for the poor.
The Wagner bill was sent to Congressional purgatory in 1946, and further efforts to enact variations of Truman’s plan were stymied by Republicans, who gained control of both the House and Senate in the 1946 midterm elections. However, Truman didn’t give up, running an underdog campaign for election in 1948 that focused his ire on the “do-nothing Congress.” And when the Democrats unexpectedly held the White House and won back Congress, the AMA felt obliged to call in favors from Republican-minded interests ranging from the American Bar Association to the American Farm Bureau Federation in order to hold the line.
Truman denounced the “same false charge of ‘socialized medicine’” used “to discredit the program and to confuse and mislead the public.” In a letter to one opponent, he argued: “When it comes to the point where a man getting $2,400 a year has to pay $500 for prenatal care and then an additional hospital bill on top of that, there is something wrong with the system.” But it was to no avail. Though Truman beat Dewey, the AMA beat Truman.
After leaving office, he called the failure of his plan the biggest disappointment of his presidency. “I have never been able to understand all the fuss some people make about government wanting to do something to improve and protect the health of the people,” he wrote in his memoirs.
All was not lost. Truman paved the way for President Lyndon Johnson to win approval in 1965 for Medicare and Medicaid — programs that now insure one American in three. LBJ signed the bill at the Truman Library in Independence, Mo., and Harry and Bess Truman were the first to receive Medicare cards.
Efforts to expand health care coverage next came from an unexpected quarter, from President Richard Nixon, who was hardly a populist but was first and foremost a pragmatist who wanted to get things done. He called for all employers to provide insurance, with a program for the self-employed to get coverage. Again, universal coverage went nowhere.
Moving right along, President Clinton made universal coverage a signature initiative in his first term, but it died in the wake of opposition from the familiar interest groups now potently assisted by Republicans who had discovered the delights of partisanship funded by hard-right money. But government-assisted health care is one of those issues that never goes away, almost certainly because the public wants it.
President George W. Bush defied Republican orthodoxy in 2003 to expand Medicare to cover prescription drugs (facilitated by ginormous government subsidies), while President Barack Obama narrowly won passage of the Affordable Care Act. Ever since, Republicans have repeatedly attempted to reverse the ACA. But there are elements of the ongoing legal effort that resemble the story about the dog who chases cars, but can’t afford to succeed. The nightmare for Congressional Republicans is that tens of millions of Americans will wake up one morning without government-subsidized coverage.
It is frustrating to think that Washington has been tussling over federal health care policy for three-quarters of a century, using the same tropes (socialism, deficit disaster, etc.) over and over again while tens of millions lack insurance and far larger numbers lack access to the sort of quality care that is routinely available in countries with far smaller economies. Could the Biden administration, bolstered by control of Congress (albeit narrow) make the breakthrough?
Certainly, Democrats will be under considerable pressure to build on Obamacare by expanding affordable coverage. However, they will need to tread carefully to thread their way through interest group opposition and Republicans who have become born-again deficit fighters. One thing’s for sure: in terms of boldness, any proposal from the current administration will pale beside what Harry S. Truman almost managed to achieve 75 years ago.