BOB GARFIELD: This is On the Media. I’m Bob Garfield. A funny thing happened on the way to the GOP repeal and replace fiasco, the sudden reemergence of the conversation about single—payer health coverage, the government being the single payer in a system financed by taxes. Long derided as socialized medicine and the moral equivalent of collectivized farming, universal taxpayer—funded health care is gaining traction.
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MALE CORRESPONDENT: And they want to see, you know, “Medicaid for all,” single—payer insurance for all, and that’s where you’ve seen Bernie Sanders talk about this, you’ve seen Elizabeth Warren talk about this. So that’s where the leadership of the Democratic Party is and, again, plenty of members of the rank and file Democrats are, are there, as well.
BOB GARFIELD: Even Minority Leader Chuck Schumer said it was, quote, “on the table.” In June, a Pew poll found that 33 percent of the public now favors a single—payer approach to health insurance, which doesn't sound like much but it is up 5 percentage points since January and up 12 points since 2014. A YouGov/Economist survey from April found 60 percent public support for “Medicare—for—all.” In the House of Representatives, Democrat John Conyers of Michigan has introduced a Medicare—for—all bill every year since 2003. Last year he had 63 cosponsors, this year it's up to 115. But don’t hold your breath.
Jill Quadagno, author of One Nation, Uninsured: Why the U.S. Has No National Health Insurance, says that the history of single—payer proposals is the history of scorched earth lobbying and PR campaigns designed to thwart them.
JILL QUADAGNO: Really, it goes back 100 years.
BOB GARFIELD: In the 1910s, proposed state laws for government health care, chiefly those in New York and California, were getting attention, but the proposals came from the wrong sort.
JILL QUADAGNO: There were immigrants from Hungary and from Germany, many of them Jewish immigrants who brought with them socialist ideas. Some of the labor unions had socialist orientations. This was considered a threat.
BOB GARFIELD: In the lead—up to World War I, the fight for national health insurance also was caught up in the fear of corrupting our way of life.
JILL QUADAGNO: When the bill for New York began to make headway, officers of the New York Medical Society called it un—American, not democratic. Their leader said it represented the first step towards state socialism. And so, that was really the beginning of this theme that health insurance is socialism. During the New Deal, President Roosevelt had considered including national health insurance in the Social Security Act of 1935, but there was opposition from the American Medical Association, in particular, that were very vocal about it. And he was not willing to risk losing Social Security for national health insurance, and so he took that out of the bill.
BOB GARFIELD: President Truman took up the mantle and he was famously persistent in trying to achieve single payer.
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PRESIDENT TRUMAN: Most of our people cannot afford to pay for the care they need. I have often and strongly urged that this condition demands a national health program.
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BOB GARFIELD: In fact, when President Johnson finally signed Medicare and Medicaid into law, he credited Harry Truman.
JILL QUADAGNO: He had been a judge in a small town. He had seen many of his clients who were sick and poor and couldn't pay for health care. So he had both a personal interest and then a politician’s interest in what he thought might be a popular and winning campaign slogan: Health Insurance For All.
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PRESIDENT LYNDON JOHNSON: Our ultimate aim must be a comprehensive insurance system to protect all our people equally against insecurity and ill health.
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JILL QUADAGNO: Republicans were very much opposed to the Social Security Act, which they saw as a government takeover.
BOB GARFIELD: In the midst of a Red Scare in which everything that looked pink would stink.
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SENATOR JOE MCCARTHY: If a person supports organizations which reflect Communist teachings or organizations labeled “Communist” by the Department of Justice, she may be a Communist.
JILL QUADAGNO: It was right before McCarthy began his hearings, Socialism, Fascism, Nazism. The American Medical Association had local chapters of physicians in every town who controlled access to hospitals, so if you lost your membership in the AMA you could be banned from practicing in hospitals. So they had a powerful weapon at their hand to become this huge lobbying force against national health insurance.
MAN: In the United States we’re frightened about socialized medicine and our medical profession is going to do everything possible to prevent the government, the federal government taking over medicine.
JILL QUADAGNO: They hired a PR firm called Whitaker and Baxter to devise a campaign against Truman's plan. And that included speeches doctors could give in their towns, literature that they could hand out to patients and so that hospitals and doctors’ offices and nurses and dentists became very involved in the fight against national health insurance. But beneath what was visible were the activities of the National Association of Manufacturers, the Chamber of Commerce and other business groups giving money supporting candidates. And so, many Democratic senators lost their seats for supporting national health insurance that died a death in the ‘40s and was not really revived until Clinton, I would say.
BOB GARFIELD: Now, the nominal argument by the AMA against national health insurance, as people continue to argue today, is that the government would get between your personal relationship with your doctor in our own agency over your own health.
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PRESIDENT RONALD REAGAN: One of the traditional methods of imposing statism or socialism on a people has been by way of medicine. Today, the relationship between patient and doctor in this country is something to be envied anyplace, the privacy, the care that is given to a person, the right to choose a doctor, the right to go from one doctor to the other.
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BOB GARFIELD: But it, it was never really about that, was it? It was about how much the docs were gonna get paid.
JILL QUADAGNO: Doctors were opposed because they were afraid that if there was a third—party payer involved that it might take over control of doctors’ charges and doctors’ practices, which is, of course, what’s happened anyway over the last century.
BOB GARFIELD: As it turned out, doctors did very well by Medicare. And by the time the Clintons in the early ‘90s were working on their health care policy, the interference was less from the AMA than the insurance companies, themselves, who got together and funded, among other things, this notorious ad [LAUGHS] that came to be known as “Harry and Louise.”
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LOUISE: But this was covered under our old plan.
HARRY: Oh yeah, that was a good one, wasn’t it?
VOICEOVER: Things are changing and not all for the better. The government may force us to pick from a few health care plans designed by government bureaucrats.
LOUISE: Having choices we don’t like is no choice at all.
HARRY: They choose.
LOUISE: We lose.
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JILL QUADAGNO: And the Harry and Louise ads echoed a theme that began, really, in the 1930s, the idea that the government would take over the health insurance and would destroy the doctor— patient relationship. You know, we see that now even when the Republicans are debating their new plan, whatever that turns out to be.
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PRESIDENT TRUMP: It’s a common sense approach that restores the sacred doctor—patient relationship.
MAN: — and a respect for the doctor—patient relationship.
MAN: And returns the relationship between a patient and his or her doctor without the government being in the middle.
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JILL QUADAGNO: It’s still the theme that hurt Harry Truman in the 1940s, that hurt Clinton in the 1990s and that's been used in attacks on Obamacare since 2010. The American Medical Association became the whipping boy for opposing Medicare but there were behind the scenes, again, these business organizations, so the AMA probably doesn't deserve all the criticism that it got because it wasn't actually as powerful. And the current position of the AMA is in opposition to the Senate bill.
BOB GARFIELD: This whole conversation is premised on the notion that even two years ago single payer was just unthinkable, politically impossible, a nonstarter. But now the fight over Obamacare and, and its repeal has kind of put national health insurance back in play. Tell me what's happening now that's kind of resurrected it as a policy option. And what about the hitherto all—powerful epithet, socialized medicine?
JILL QUADAGNO: You know, that comes and goes in waves, and so I think it will always be a part of American politics. But I think the one problem the Republicans are having now is finding a message, crafting a message that explains what they're doing to the public. And so, I think that's also helped the single—payer idea, the fact that the Republicans don't really have a good explanation for what they are doing. The antigovernment theme isn't working very well when so many more people now have Medicaid or health insurance through the exchanges. And we find that the younger you are, the more likely you are to support government—provided health care for everyone. For younger people, their whole lives Medicare has been there, Medicaid has expanded enormously. Medicaid is now almost as popular as Medicare, and so that idea now is resonating with the public much more than the idea that the government doesn't have any responsibility and has to get out of the health care system completely. People just don't buy that anymore.
BOB GARFIELD: But now I am thinking of same—sex marriage. It was politically untenable. In fact, it was one of the huge arguments of the culture wars and it was used as a bogeyman by Republican candidates. Is this a turning point, in the same way, for single payer? I mean, could it be the “gay marriage” of health policy?
JILL QUADAGNO: I don't think so. You’re facing different kinds of political problems. Gay marriage was one single thing that had to be done: let gay people marry. This would involve multiple different activities, maybe several bills.
BOB GARFIELD: And one—sixth of the entire economy.
JILL QUADAGNO: Yes, it would affect almost half of the public who already have some form of government insurance through Medicare, Medicaid, veterans’ benefits, state workers, federal employees, retirees and many more actors and players, including hospitals, doctors, medical associations, AARP, just a much more complex issue than gay marriage.
I think that this could be a turning point in terms of the effort to replace and repeal Obamacare, for sure, but what will happen next is much less clear, and I don't think either party has really decided what it will offer to the American public.
BOB GARFIELD: Jill, thank you very much.
JILL QUADAGNO: My pleasure.
BOB GARFIELD: Jill Quadagno is the author of One Nation, Uninsured: Why the U.S. Has No National Health Insurance. She is also Professor Emeritus of Sociology at Florida State University.
