WASHINGTON — Many have tried, and almost all have failed — but Barack Obama stands on the brink of becoming only the second U.S. president in history to achieve a sweeping overhaul of the country’s troubled health-care system.
The Senate’s US$849 billion bill is ready, but health-care reform faces its toughest test on Saturday, when senators convene for a rare weekend session to vote on whether the debate on the bill can begin — its first hurdle before heading towards a historic finish line.
That vote needs the support of every Democratic senator. Harry Reid, the Senate majority leader, has recruited an all-star team of former senators, including Vice President Joe Biden and Tom Daschle, to convince reluctant conservative Democrats to co-operate.
He hasn’t said whether he believes he’s secured all 60 votes.
At a noontime rally with supporters, Reid evoked another Democratic president who tried, unsuccessfully, to reform U.S. health care.
Harry S. Truman, Reid said, knew the health of the American economy was linked to the health of the American people.
The bill “is not just a milestone in a journey of a few months or a few years,” Reid added.
“We have been working to reform health care since the first half of the last century.”
Indeed, universal health care of the type Canadians now take for granted has been an elusive goal for almost 100 years in the United States.
In 1912, Theodore Roosevelt’s Bull Moose party campaigned on a platform calling for health insurance for industry, and as early as 1915, progressive reformers campaigned in eight states for a state-based system of compulsory health insurance.
Their push for group medicine and voluntary insurance sparked vehement opposition as the term “socialized medicine” was born — a demonizing phrase that persists almost 100 years later among those most vehemently opposed to Obama’s plans, and one that was used as a battle cry during Canada’s own political skirmishes to introduce a national, universal health-care system in the 1960s.
Franklin D. Roosevelt advocated for national health insurance but opted instead to focus on jobs and retirement security during the Great Depression in the face of opposition from organized medicine, including the American Medical Association.
Truman, Roosevelt’s successor, fought for a single-payer system, similar to Canada’s, but was stymied by Republican opposition in Congress — and, again, the cries of “socialism” from organized medicine.
Richard Nixon wanted to expand the employer-based insurance system and broaden protection for the poor, but he was stopped short by the Watergate wire-tapping scandal that resulted in his resignation.
And the most famous recent attempt, Bill Clinton’s, died a bitter death under assault from its numerous Republican opponents after the 1994 mid-term elections eroded Democratic strength in Congress.
It’s only Lyndon Johnson — like Obama, blessed with large Democratic majorities in both chambers of Congress — who achieved significant reform with the passage of Medicare and Medicaid to provide coverage to the elderly and the poor. He signed the legislation with a beaming Truman by his side.
Johnson had two other advantages that Obama has lacked — the economy was robust in the mid-1960s, and the longtime Texas lawmaker had a talent for congressional persuasion, particularly among the southern Democrats who had voted against health-care reform in the past.
“I do understand power, whatever else may be said about me,” Johnson once said. “I know where to look for it and how to use it.”
Johnson also regarded health and education as essentials in a civilized society.
“I’ll go a 100 million or billion on health or education,” he said in a conversation with his vice-president, Hubert Humphrey. “I don’t argue about that any more than I argue about Lady Bird buying flour. You got to have flour and coffee in your house. And education and health, I’ll spend the goddamn money.”
Johnson’s daughter, Lynda Johnson Robb, recently came forward to remind Americans about her father’s legacy while urging them to support Obama’s efforts.
“Ensuring all Americans have guaranteed affordable health care is the missing piece of the modern American social contract,” she said in a video released by the Alliance for Retired Americans. “My father overcame similar opposition in the fight for Medicare. With your help, we can overcome again.”
Reid’s massive, 2,074-page bill would require most Americans to have health insurance, and would provide hundreds of billions of dollars in subsidies to enable those with lower incomes to afford coverage.
Employers would not be required to offer coverage, but medium and large companies would pay a fee if the government ended up subsidizing their employees’ insurance.
Under the current system, health insurance is increasingly unavailable to many poor and lower-income Americans. About 47 million U.S. citizens now lack health insurance, and those who do have coverage have found themselves paying higher premiums for fewer benefits in recent years.
Skirmishes between insurers and hospitals over who pays the bills is gobbling up so much money that the U.S. now pays almost twice as much per capita as Canada yet has a lower life expectancy and a significantly higher infant mortality rate.
As well, approximately half of all personal bankruptcies in the U.S. are related to health-care costs.