President Barack Obama’s campaign for a health care overhaul is an intense installment in a long-running story, dating to Theodore Roosevelt in 1912.
It did not go well nearly a century ago. Roosevelt made national health insurance an issue in his last, losing campaign for the White House, and successive efforts to get it enacted have lost, too.
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The basic issue, affordable health care for all Americans, has not changed. But possible solutions have not evolved either, in part because new proposals seldom build on old ones. Obama’s broad, leave-the-details-to-Congress proposal has little in common with the 1,300-page measure President Bill Clinton couldn’t even get to a vote in a Democratic Senate in 1993.
The Obama strategy was designed to avoid mistakes Clinton made in confronting Congress with a massive bill written in the White House under the management of Hillary Rodham Clinton and essentially telling the House and Senate to take it or leave it. Clinton threatened to veto any bill that did not deliver universal health care. He got nothing to veto.
Obama’s push for action before the summer recess created a goal the Democrats couldn’t meet and a psychological setback he didn’t need to risk.
Franklin D. Roosevelt wanted national health insurance but, even with his power in the New Deal Congress, he did not dare to tie it to Social Security in 1935 lest he lose the whole program. Harry S. Truman pushed it on a Congress that wouldn’t buy it.
While Dwight D. Eisenhower balked at national insurance, he tried to get Congress to support a reinsurance program to buttress private insurers and gain coverage for high-risk patients and the needy.
Congress said no, twice.
John F. Kennedy made health care a major issue in his 1960 campaign. He concentrated on what then was called medical care for the aged, a title that wouldn’t play well with the current Medicare set, people now described as senior citizens. He couldn’t get it through Congress.
Lyndon B. Johnson did, but even with his legendary legislative skills and the overwhelming Democratic majorities in Congress after the 1964 elections, it took more than a year of hard, sometimes arm-bending persuasion to get Medicare enacted. It was a hard sell with conservative Democrats, not unlike the problem Obama faces now.
That one major victory for government health insurance was an exception to the pattern of starting each attempt from scratch instead of evolving it from what had gone before.
It provided government health insurance at age 65, tied to Social Security. Broader coverage, which FDR, Truman and Johnson all would have liked to gain, was beyond political reach.
Not only for LBJ, but also for Republican Richard M. Nixon, who proposed universal health insurance in 1974, seeking to use employer-based coverage along with federal subsidies so that all Americans would be insured. It was to be done by private insurers, not the government. There was bipartisan support until Watergate intervened.
