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Placing Current Reform in Historical Context
Presidents like Franklin D. Roosevelt, Harry S. Truman, and Lyndon B. Johnson attempted to create national health programs for Americans. Eventually, plans turned to a fight for care for a specific age bracket of Americans and, in a span of thirty years, ideas for Medicare and Medicaid came to fruition.
Under LBJ, like today in Washington, D.C., Democrats controlled the executive branch and the Congress. They outnumbered Republicans and were able to shift committees that had traditionally created obstacles for social health programs.
Interestingly, when it came time to debate reform, as with the current health reform plans being discussed, three forms of the bill were offered: one by Republican John Byrnes, one by the American Medical Association (AMA), and one by the president. The AMA bill was not included in final plans for Medicare or Medicaid but Byrnes' plan that doctors' services and drugs be financed and participation in government aid be voluntary was included.
So, with Medicare and Medicaid being signed into law under the Social Security Act of 1965, you had one of the most sweeping overhauls of health care policies in America in the history of the United States.
You also had a template developed that would be followed consistently decades after Johnson's presidency: fill gaps in coverage but do not challenge privatized health insurance or the medical profession's right to set fees.
With Medicare and Medicaid, government intervention created huge profits for the medical-industrial complex in America. That's also what would happen with current health reform being discussed.
The reform would impose some new regulations on private insurers, but, like the credit card regulations recently passed, insurers would have a window to raise premium rates and they would also be ensured a multitude of new consumers.
The public option would remove the private insurers' obligation to insure the unhealthy, the unemployed, and the poor and splits the pool. It would force government to cover the most expensive pool under a weak public option that is designed to fail and it protects and strengthens the private health insurance industry of America.
When placed in context, it should not be surprising that this is where we are at with healthcare. Clinton's handling of Medicare provides a great example of why this should have been expected.
As Lance Selfa explains in Democrats: A Critical History, Clinton embraced "bipartisanship" like Obama has when he removed billions of dollars from Medicare and Medicaid during his presidency. Through the 1997 Balanced Budget Agreement (BBA), he endorsed the congressional Republican leadership's long-term goal of gutting spending on "entitlements" like Medicare and Medicaid.
"The BBA imposed draconian spending "caps" on "discretionary" programs from home heating assistance to legal services. These austerity measures accounted for the first-ever annual decline in Medicare spending in 1999. Between 1997 and 1998, the number of sick and elderly receiving Medicare-financed home health care services fell and astounding 45 percent, with six hundred thousand fewer people receiving care. Under the BBA, Clinton literally abandoned millions of poor, elderly and disabled Americans. "
Like Clinton, in Obama's first year, Americans have already seen Obama squeeze Medicare by offering a budget proposal that would halt higher payments that the government gives insurers who cover Medicare beneficiaries through private Medicare Advantage plans.
Obama hopes to help pay for current plans(like the plan that passed the House) by squeezing "$404 bilion out of the projected growth in Medicare and other federal programs over 10 years, including $117 billion from cuts in Medicare Advantage plans. The government pays about 14 percent more for the private plans than it would pay for the same people in traditional Medicare."
What happened with the Clinton-Gore agreement laid the groundwork for "moving Medicare from a system guaranteeing a set of minimum benefits for all to one that allowed patients who could afford it to opt out and buy their own insurance."
Under the Senate plan, states could opt out of the already weak public plan being offered as part of health reform.
