Medicare was an idea that took time, decades, in fact. Maybe health care reform will take as long. Good ideas often come slowly.
Where do ideas come from?
When it comes to discussions about health care reform – strike that, this is now officially an “insurance reform” proposal – lobbyists, company bosses, experts, attorneys, bureaucrats and politicians dictate the sentences in the conversations. Across the country voices from town halls only serve to add spice to the narrative. The deal will be struck based on the simple but absolute requirement in politics: What will earn enough support to pass Congress?
But Montana Gov. Brian Schweitzer recently tossed out another idea. I don’t think he was talking about health care – but he should have been – when he said that the Obama administration should listen to the tribes to sort out the complicated issues facing the country.
“In the heartland in a place like Montana, we have people who have lived sustainably on the land and they may well have the ideas of the future. All great ideas don’t start in Washington, D.C.,” Schweitzer said.
I wonder what the town halls would have been like had the president heard and followed this advice. The discussions certainly would have been more about health care than insurance if the conversation included clients from one of the half-dozen Indian Health Service units in Montana. Indeed, there are only three segments of the U.S. population that now receive direct “government-run” health care: Native Americans, veterans and inmates in federal prisons.
Yet in the battle of ideas, the programs that the federal government already operates are not part of the discussion. Go figure. It was much the same when Medicare was created, too.
New Mexico Sen. Clinton Anderson – when he wasn’t busy championing tribal termination – was the architect of the Senate’s Medicare legislation beginning in the late 1940s. Back then Republicans labeled the very idea of government insurance as “socialist.” Anderson wrote in his memoirs, “Outsider in the Senate,” that some members of the Republican minority “always seem to take pleasure in defeating social legislation, as if that’s how the country’s problems are solved.”
Anderson proposed a health care extension of Social Security in 1960, and the leader of the Senate opposition wasn’t a Republican, but Oklahoma Democrat Sen. Bob Kerr. “It’s never been quite clear to me why Bob – given his overall social philosophy – should have considered it almost a religious mission to defeat a medical-care program insured by the Social Security system. It was one thing to have reservations,” Anderson wrote. “It was quite another to become a crusader sworn to the program’s death.”
Then, like now, Kerr and his allies had an important weapon, money. Anderson said he once took Joseph Montoya to see Kerr when Montoya was running for a House seat. “Bob walked over to a locked safe, turned the combination and peeled off a number of bills, which I think was $1,000 and handed it over,” he wrote. This earned Kerr gratitude for later fights.
But Kerr died in 1963 – and it was another Democrat, Russell Long, who led the opposition. Legislative action had to wait until after the 1964 election. (Anderson, for his part, told President Johnson that he had reserved “Senate 1” for a new Medicare bill.)
“On July 30, 1965,” Anderson wrote, “I joined President Johnson aboard the presidential jet, Air Force One, for a flight to Independence, Missouri, where the bill was to be signed. In the presence of Harry S Truman, under whose leadership I had first begun to think of a national health insurance program almost two decades before, the bill became law.”
Anderson wrote that it would have been easy to settle for less along the way, but in fact the intensity of the opposition helped strengthen the legislation. “The long rearguard action which the American Medical Association conducted enabled us, in effect, to enact not a skimpy law but one which went far toward meeting the real needs of both the elderly … and the poor (Medicaid). I was thrilled with the triumph and proud of our work.”
Think of the time frame: Medicare started as a general welfare philosophy under President Roosevelt. Then the idea emerged stronger under President Truman – finally becoming a bill in 1960. That idea died. More than once. But it was only “dead” until the legislation was signed into law in 1965.
Perhaps good ideas take time – a little perspective on the 2009 deadline for health care reform.
Mark Trahant is the former editor of the editorial page for the Seattle Post-Intelligencer. He was recently named a Kaiser Media Fellow and will spend the next year examining the Indian Health Service and its relevance to the national health reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes.