The first serious foray into government provided health insurance was by the Progressive Party under Theodore Roosevelt (TR) in 1912. It is important to understand that this was in the context of an overall strategy by TR to gain control over what was perceived as a blight of runaway corporations who were engulfing the resources of the country and hoarding indefensible profits on the backs of the common worker. The industrial revolution was in full swing and the astronomical growth of the economy (a good thing) had caught government off guard. The inherent slowness of government to react reasonably (a bad thing) had resulted in a huge populuous movement to reign in the corporate powers and restore the riches of the country to it's 'rightful' owners, the people who produced it. If that sounds familiar, it should. Several liberal politicians of our age have echoed the same sentiment, though I propose, with much less sincerity than Mr. Roosevelt. There was a sense that balance needed to be restored between business, labor and consumers. While Woodrow Wilson proposed doing so by weakening business, Roosevelt believed in doing so by strengthening the other two. As part of this attempt, the Progressive party endorsed social insurance as part of the platform in an attempt to beat Wilson and Taft in the upcoming presidential election. Another important note to make here is that it was more political than altruistic. (TR The Last Romantic, H.W. Brands 1997. -- Timeline: History of Health Reform in the U.S., Kaiser Family Foundation 2009 [kff])
TR's cousin Franklin Delano Roosevelt (FDR) would again take up the banner for universal health coverage during his terms as President of the United States. However, FDR was acutely aware that this could end up torpedoing his primary concern, the Social Security Act (1935). In the end, FDR abandoned the inclusion of universal health coverage in the Social Security Act in the interest of easing it's passage through both houses of Congress. Interestingly, this began a decades long give and take between the American Medical Association (AMA) and government, in which the AMA fights legislation in the beginning of the political process but then lobbies for access and control, quite successfully, towards the end of the process when legislation seems eminent. (Despite popular belief the AMA does not represent 'doctors'. Only 20% belong.)
One must not diminish the importance of this administration in the eventual takeover of private industry by government. FDR was much more liberal than his public persona, believing in "cradle to grave" protection, including health insurance for all Americans. He always believed that these programs would lead to an ever more dependant class needing ever more government assistance, from guess which party? Within the first hour of their meeting to determine her nomination for Secretary of Labor, Frances Perkins and FDR had agreed upon much of the social welfare system as it has existed since. To Ms. Perkins astute observation; that much of this government involvement would be considered unconstitutional; FDR stated that "...we can work something out when it comes." This of course, would lead to the famous Supreme Court packing incident that was the eventual demise of FDR's perpetual presidency. (FDR was the first and only president to break with George Washington's tradition of only serving two terms as President of the United States) Make no mistake about it, this again was about power and money, not charity to the American public. As the debate in Congress was going on about the New Deal proposals, FDR waivered back and forth as the political winds blew. Frances Perkins was ever frustrated at his lack of solid support. Another clue into the political as opposed to ethical aspect of these programs was the fact that negroes need not apply. Yes, that is correct, Social Security, unemployment insurance and minimum wage under FDR all had employer exemptions that allowed for discrimination against blacks. New Deal programs lead to the fundamental change of the federal government from one that was meant to protect a citizens rights and access to the means to 'pursue' happiness, to one that provided 'happiness' in the form of security. Politicians to this day are abusing this corruption of the Constitution to bring fear to elderly and poor citizens claiming their 'rights' will be taken away if they vote for the wrong party. (The Defining Moment-FDR's Hundred Days and the Triumph of Hope, Jonathan Alter 2007.)
Though FDR did not include health coverage in the Social Security Act (SSA), it in no way stopped the government infusion into this private industry. While politicians from Truman to Kennedy attempted to gain traction for universal health care a plethora of government programs, mandates and regulations began the long trek towards complete government takeover. These include but are not limited to:
The inclusion of grants for Maternal and Child Health in the SSA, essentially restoring the Sheppard-Towner Act.
The Interdepartmental Committee to Coordinate Health and Welfare Activities.
National Health Survey.
Department of Health and Human Services is established as Federal Security Agency.
Attempt to pass the Wagner-Murray-Dingell bill in 1943 for cradle to grave coverage.
FDR's economic 'Bill of Rights' 1944.
Social Security Boards call for compulsory national health insurance.
Hill-Burton Act 1946.
1949 SCOTUS affirms National Labor Relations Board rule that benefits may be part of collective bargaining, strengthening labor unions.
1950 National Conference on aging.
1951 Joint Commission on the Accreditation of Hospitals.
Federal Security Agency becomes the Department of Health, Education and Welfare.
In 1965, the Johnson administration pushed through the Social Security Act which included single payer health care for seniors (Medicare) and single payer coverage for the 'poor' (Medicaid). At the time opponents to the bill claimed that the predictions of costs were grossly understated. History has shown that even they had no idea how much of the federal budget would eventually be spent on these programs. Once again, the original intent was to have complete government control of healthcare, but once again they were willing to use an incremental strategy.
In 1995 Robert Ball (Social Security administrator under Kennedy, Johnson and Nixon), made the following astounding admission...30 years after the fact:
"For persons who are trying to understand what we were up to, the first broad point to keep in mind is that all of us who developed Medicare and fought for it...had been advocates of universal national health insurance. We all saw insurance for the elderly as a fallback position, which we advocated solely because it seemed to have the best chance politically. Although the public record contains some explicit denials, we expected Medicare to be a first step toward universal national health insurance, perhaps with "Kiddicare" as another step."
Robert M. Ball, "Perspectives on Medicare: What Medicare's Architects Had in Mind," Health Affairs (Winter 1995): 62-72
Think about this for just a second. Here is a top administration official, admitting that the entire administration was consistently lying to the public in order to achieve their utlimate goal. If your goal is simply helping people, why on earth would you have to lie? However, what if your goal was more sinister? What if your goal was centralized governmental power over the people? What if your goal was known to be completely unconstitutional? Now THAT is a reason to lie!
If you still do not believe in the incremental approach to full governmental control of health care, peruse the following list of additions to Medicare/Medicaid since 1965:
1967-Social Security amendments broaden Medicaid coverage and add Early and Periodic Screening and Diagnostic Testing (EPSDT) benefits
1972-Medicare benefits are extended to persons under 65 with disabilities (the definition of which will change over the years) and persons with End Stage Renal Disease (ESRD)
1974-Health Planning Resources Development Act mandates state programs for health planning
1977-Health Care Financing Administration established under the Department of Health, Education and Welfare
1980-Home Health benefit under Medicare broadened. Medi-gap supplemental insurance brought under federal control
1981-Federal Budget Reconciliation (OBRA 81) puts additional mandates on states regarding pay and coverage of Medicare services.
1982-States allowed to expand Medicaid coverage to certain children with disabilities. HMO's are added as an option to garner more plan participation. Hospice benefits are added.
1983-Federal employees are required to participate in Medicare
1985-Medicare mandatory for newly hired state and local government employees
1986-Federal Budget Reconciliation (OBRA 86) loosens qualifications for coverage for the poor
1987-National Medical Expenditure Survey collects information on households from medical and insurance providers
1988-Medicare Catastrophic Coverage Act greatly expands Medicare coverage. Though the act is repealed the next years, some elements are maintained such as state mandates for paying premiums for poor.
1989-Federal Budget Reconciliation (OBRA 89) mandates coverage for pregnant women and children under 6 at 133% of the poverty line
1990-Federal Budget Reconciliation (OBRA 90) mandates coverage of children 6-18 under poverty line
1993-Hospital Insurance (HI) payroll tax applied to all wages rather than the lower capped SS amount. States required to expand coverage and benefits. Clinton Administration attempts complete health care takeover by the government but fails amid stiff resistance.
1997-Balanced Budget Act mandates extensive changes in Medicare and Medicaid. Some intended to cut administrative costs, others to expand coverage and benefits including Medicare+Choice (optional managed care plan). Interestingly, payments must be reduced to providers to maintain solvency of HI which began only 4 years previous. State Childrens Health Insurance Program is adopted with block grants to states to cover federal mandates. States are allowed to cover working disabled up to 250% of poverty line.
2000-Breast and Cervical Cancer Treatment and Prevention Act allows Medicaid coverage for breast and cervical cancer treatment regardless of income or resources
2003-Medicare Drug, Improvement and Modernization Act creates a voluntary prescription drug benefit under Medicare. Benefits provided under private plans and Medicare Advantage (formerly Medicare+Choice). Interestingly, many seniors opt for this plan without knowing their benefits actually decrease and they pay for services previously covered under Medicare (field observation by RN).
Legislation allows for Health Savings Accounts (HSA's) in conjunction with high deductible insurance plans.
2005-Deficit Reduction Act makes broad changes in premiums, cost sharing, benefits and asset transfers
2007-Many legislative attempts are made to expand or limit Medicare coverage, change tax exemptions and deductions, or extend S-CHIPS. All fail to be passed by Congress and/or signed by the president. Political divide on government provided health care widens with democrat Congress and republican President.
(kff, -- "Medicare, a profile, Celebrating 35 Medicare, Chronology of Legislative Activity" 1990)
This list is thorough but not comprehensive. Regardless of the obvious good intentions or seemingly charitable outcome, the stunning reality is that once government becomes involved in any industry, the tendency is to become ever more restrictive in that industries day to day operations. If you care to read any of the above legislation pay particular note to the use of the words: allow, mandate, require, regulate, fine, tax and fee.
Medicare and Medicaid costs, as a percentage of the Gross Domestic Product has tripled since 1970. If left alone, Medicare/Medicaid spending could be as much as 19% of GDP by 2082. Government spending on health care now makes up approximately 45% of all health care expenditures in the United States. In the meantime, out of pocket expenses for recipients has gone down from 33% to 15% with projections of 13% by 2015. 25% of the beneficiaries account for 85% of expenditures. (Congressional Budget Office)
Social security, Medicare and Medicaid were over $1,000,000,000,000.00 in the fy 2006 federal budget. Despite popular belief, Medicare spending is only 53% funded by payroll tax. The rest comes from the general fund. (U.S. federal budget fy 2008 - Mandatory spending)
Now, put your thinking cap on. What happens when you give something to people, then you constantly expand what they can get while lessening their personal burden? Exponential growth, increased demand for benefits, ever expanding sense of entitlement. One thing that politicians will always rely on is the old adage that you can't prove a negative. In other words, no one can say what the condition of our health care system would be today if government had stayed out of it. Some historical data shows that the best way to increase medical care is to increase economic standards for all people. Our economy has grown by a factor of 20 in the last 40 years. How can anyone assert what the rate of uninsured would be if government regulation and control of almost 50% of our healthcare system did not exist? How can one know what the effect on the cost of health care would be if the government did not take out the needed revenue from everyones paycheck? How can one know how much more the economy would have expanded if government expenditures did not include government run health care? How can one know what the effect on the value of the U.S. dollar would be if the federal government was not so deep in debt? Very simply you can not. What one can do is to empirically prove what happens when government does control a large portion of health care. Costs go up, use expands exponentially, personal responsibility plummets, freedom is incrementally reduced, government mandates and regulations expand, free market solutions are stifled, doctors become disillusioned, etc. etc. etc. And the most tragic is that society tends to look only to government for solutions when in fact government is what is wrong.
All of the above is irrelevant. Yes, that's what I said, irrelevant. The reason is that everything that government has done, from Social Security to the GM bailout is unconstitutional. These things do not provide for the 'general welfare' of the U.S., they provide for the 'specific welfare' of individuals and businesses. The Constitution gives the federal government the power to 'regulate' interstate commerce. In the context of this clause, regulate means to 'keep regular' or to keep states from impeding each others ability to conduct business within these United States. A perfect example would be the ability to purchase insurance from another state. This is an area that the government should be involved in to the extent that it should remove barriers preventing this interstate commerce from occurring. The sad truth is that the exact opposite is being done. Government regulation now prevents such purchases! Nothing in the Constitution gives the federal government the authority to take over industries such as health care, insurance, banking or car manufacturing. And yet, they do, and are even arrogant about it to the extent that any critics of this oppression are laughed off as extremists or out of touch. This arrogance and condescension is precisely why our founding fathers warned against too much control being afforded a central government. Never forget that power corrupts.
If allowed to continue, and there is little chance it won't, the federal government will indeed, one day control the entire health care industry. What this means for the average American is that almost every aspect of your daily lives will become a line item to the bureaucracy. Holding down costs will be their constant mantra, because without personal responsibility and with coverage for all and coverage for everything, the cycle begun by Medicare/Medicaid will only be exacerbated. That means that if you ride a motorcycle, you are at a greater risk to require medical care. If you don't exercise properly you will be more likely to need heart medication. If you swim, boat or participate in any sport your risks of injury will be higher. All of this will be studied, numbers will be crunched, recommendations will be made, regulations will be made, mandates will flourish and taxes will rise constantly. The government will allow some activities while discouraging others. Once medical care is completely provided by government, then all activities that may lead to medical care; in other words living your life day to day; will become a point of interest to the bureaucrats in Washington D.C. whose mission it will be to constantly work to lower health care expenditures and increase tax contributions. If left alone as is, Medicare/Medicaid will consume the federal budget before the end of this century. That level of spending is unsustainable. Cuts will have to be made and revenues will have to be increased.
The indisputable evidence is that the federal government has caused more problems in the health care industry than it has solved. It has taken responsibility out of the health care equation. It has caused costs to increase with regulation and mandates. It has corrupted the political process by collusion with certain industries and unions. It has spread it's power and authority without regard to it's Constitutional mandate. It has encouraged future constitutional abuses. It has methodically forced dependency on a large portion of the population. And, most despicably, it has bankrupted future generations for it's own short term power trip and called it compassion.
Ladies and Gentlemen, it is about power and money. It has always been about power and money. It will always be about power and money. Our forefathers knew this. That is why they constantly admonished that all government by it's very nature is corrupt. The only way to minimize the effect on the liberty of the people is to diminish governments role in daily life as much as possible. It's not about the details, it's never about the details. It's about the philosophy. Big government=less freedom. Small government=more freedom. Freedom promotes ingenuity, invention and production. Government diminishes all three. The title of this blog is ignarus semino dominatus, ignorance breeds tyranny. The acceptance by a large portion of the populous of these States United, of Social Security and government health care are perfect examples of the truthfulness of this old idiom.
What is the solution? My next blog post Health Care Solutions for American will solve these problems constitutionally if we, the American voters, have the character and resolve to implement it.
by: Keith D. Rodebush
Charts for reference: