In health care, sometimes the past lies well ahead of the future. Now that the American Health Care Act has failed again, it’s time to consider past health care proposals, especially from a Republican president.
In 1972, Richard Nixon gave a special address to Congress. American health care, at $75 billion a year, was far too expensive and ineffective, he declared. What was needed was a program that recognized a strong nation and a powerful economy required a healthy population. In Nixon’s words:
“In the ultimate sense, the general good health of our people is the foundation of our national strength, as well as being the truest wealth that individuals can possess.“
“While we emphasize preventive maintenance for our automobiles and appliances, we do not do the same for our bodies. The private health insurance system, good as it is, operates largely as standby emergency equipment, not coming into use until we are stricken and admitted to the most expensive facility, a hospital.”
Nixon had worked on public health areas before. He had signed into law the National Cancer Act, the “war on cancer,” which very much continues. The VA was reorganized to take care of soldiers from the Vietnam War, and a national health service corps developed for poor and rural areas. In 1973, funding for the FDA went up 70%. He also produced a whole new series of public health initiatives including special programs on alcoholism, drug abuse, sickle cell, family planning, venereal disease, health education, a toxic substances control act, and the creation of a consumer product safety group. One of his later initiatives targeted health information, making its integration central to a national, universal health care system:
“Equal access for all to health care: We must do all we can to end any racial, economic, social or geographical barriers which may prevent any citizen from obtaining adequate health protection.”
Everyone would be covered:
“This proposal for a comprehensive national health insurance program, in which the public and private sector would join, would guarantee that no American family would have to forego needed medical attention because of inability to pay.”
The real enemy was poverty:
“One of the greatest hazards to life and health is poverty. Death and illness rates among the poor are many times those for the rest of the Nation. The steady elimination of poverty would in itself improve the health of millions of Americans.
H.R. 1’S main purpose is to help people lift themselves free of poverty’s grip by providing them with jobs, job training, income supplements for the working poor and child care centers for mothers seeking work.”
To Nixon, health was defined not as health care, but as public health. Public health required that there be health care for everyone, job training, income supplements for the working poor and childcare to benefit the nation’s overall economic strength. Having watched two of his brothers die while he was a teenager, one of TB, Nixon knew what he was talking about. The result was his own comprehensive health care plan.
Nixon Health Care
In the 1972 address, Nixon described his plan that would cover everyone. For the elderly, Medicare. For the “aged poor, the blind, the disabled and some children,” Medicaid. The bulk of the population would be covered by employer required health care, with every employer compulsorily tasked to provide health insurance for employees. For those without insurance, a Family Health Insurance Plan would be set up primarily based on HMOs.
The main opposition to Nixon’s plan was Teddy Kennedy’s approach for a single payer system. Nixon was opposed to single payer in part because of cost; he stated he did not think the American people could “take the burden” of paying $1000 a year so everyone would be covered by the government.
Yet the main political problem remained health insurance companies. They regarded such government insurance as putting them out of business. The “public option” was totally unacceptable to health insurers, which killed Kennedy’s approach.
In 1974, Nixon began to compromise with the Democrats. There would be a “Comprehensive Health Insurance Plan” covering all. The reason, he felt, was obvious:
“Without adequate health care, no one can make full use of his or her talents and opportunities. It is thus just as important that economic, racial and social barriers not stand in the way of good health care as it is to eliminate those barriers to a good education and a good job.”
CHIP would not allow any major exclusions of care, nor for preexisting conditions or for mental health:
“There would be no exclusions of coverage based on the nature of the illness. For example, a person with heart disease would qualify for benefits as would a person with kidney disease.
In addition, CHIP would cover treatment for mental illness, alcoholism and drug addiction, whether that treatment were provided in hospitals and physicians’ offices or in community based settings.”
Last, everyone would get a national health care card:
“This card, similar to a credit card, would be honored by hospitals, nursing homes, emergency rooms, doctors, and clinics across the country. This card could also be used to identify information on blood type and .sensitivity to particular drugs-information which might be important in an emergency.”
As in other countries, this national health card would provide personal information and guaranteed health care.
Kennedy and Nixon were close to a compromise bill when Watergate swept Nixon from the presidency.
Today, health care is a $3.3 trillion dollar industry, not the $75 billion of 1972. National programs like Medicare cost 4-5% to administer, while health insurance administrative and profit requirements generally begins around 20%, and go to 35%. The minimum difference, fifteen percent of $3.3 trillion, is nearly half a trllion dollars. That administrative cost differential alone is one of the reasons many economists declare American health care wastes at least a third of its money.
Many political resources will work vigorously to continue that historic waste. Health care companies could spend one percent of their revenues on lobbying and public “persuasion” and have perhaps $20 billion each year, accreting to $80 billion in a presidential election year, to buy large parts of the political class. They already have succeeded. As they have discovered, the cost is much cheaper than their means.
Yet the message that Nixon gave to the country 45 years ago remains: healthy populations make you strong. A healthy economy requires a healthy population. A healthy population requires a safe and healthy environment. Health, powerfully affected by nutrition, sanitation, poverty, and environment, is the real issue controlling health care and ultimately, national strength.
Ask yourself – is our health care system better off now?
Often we must look backwards to go forwards. Those who do not recall the past forget the future.