National Health Insurance Debate

Size

Critics of America's health care system see two extremes. On one extreme are people with well-paying jobs and benefits,especially in public employment, who enjoy Cadillac-style coverage for doctor's visits, tests and drugs. On the other are an estimated 47 million Americans who cannot afford health insurance and forgo critical treatments that could improve or prolong life. This leads to a patchwork quilt of programs serving specific niches, such as children, but nothing in between. According to the National Coalition on Health Care, roughly 16 percent of America's Gross Domestic Product is dedicated to health care, or double what European countries like France are spending. By most objective measurements, America's system is consistently ranked near the bottom in terms of access, efficiency and equity.

Harry Truman announces his health proposal to a hometown crowd in Independence, Missouri.

The roots of the national health insurance debate can be traced to the Depression-ridden 1930s, when President Franklin Delano Roosevelt looked to adopt such a system into his New Deal legislative agenda. but ultimately, backed away. Roosevelt's successor, Harry Truman, proposed a government-run national health insurance fund that would pick up the costs for any doctor joining it. Both efforts foundered in the wake of a successful campaign to link them with communist or socialist approaches. First Lady Hilary Clinton led the next major effort in 1993 by suggesting that employers could provide coverage through loosely-regulated pricing cooperatives.The plan foundered amid conservative congressional opposition and a $17 million attack ad blizzard financed by the Health Insurance Association of America.

An example of the infamous "Harry and Louise" attack ads.

Buoyed by public antipathy to what they mocked as "HilaryCare," Republicans recaptured the U.S. Senate and House of Representatives in 1994. National health care effectively fell off the radar until the 2007 credit and housing meltdown that threatened Americans' livelihoods. Massachusetts Governor Mitt Romney made his state's adoption of a statewide system a centerpiece of his unsuccessful 2008 bid for his party's presidential nomination. Democratic rivals Barack Obama and Hilary Clinton also embraced the single-payer cause, while sparring sharply on whose plan would benefit more people. The degree of support for a European-style approach remained unclear, though consensus seemed to be growing to insure the working poor, and children--a priority in Obama's approach of trying to make insurance more affordable to low-income people.

A "Harry and Louise"-style Obama campaign ad.

National health care opponents start by asking a pointed question--if such a system is so beneficial, why do the Canadians covered by it cross the border for specialized treatments? Opponents also claim that a national system will impose layers of bureaucracy, stifle innovation in new drugs and research, and yield to further inequality or rationing. Proponents retort that, in the world's wealthiest nation, denying even basic care to so many people is morally wrong. In their eyes, raising fears about socialized medicine is meant to steer discussion from the bloated payrolls and secretive decision-making that characterizes the health care industry. Supporters argue that it is easier to hold government bureaucrats accountable than their private industry peers.

In 2008, Harry and Louise returned for ads touting health care reform as a priority.

Although presidents have often looked across the Atlantic for inspiration, experts on both sides of the debate agree that any overhaul of the current system should take several ominous developments into account. Lack of regulatory controls has enabled health insurance costs to rise far above the inflation rate, forcing many small employers to stop offering their employees coverage. With one out of every two Americans employed by a small business, or operating one of their own, this is not an insignificant issue. Roughly 28 of the 47 million uninsured Americans are also self-employed, so they will need a place at the table. Full-time employees are having to pick up more of the cost, draining the economy of badly-needed consumer spending, and potentially bankrupting more people in case of catastrophic illness.