Monday, August 3, 2009
Posted by John S. Wilson at 7:56 PM
Revisionist History: What we can learn from the 1921 health debate today.
By John S. Wilson
What We Can Learn From the 1921 Health Care Debate -
"He's conducting a dangerous experiment with our health care. He's conducting a reckless experiment with our economy. And he's conducting an unnecessary experiment with our tax dollars—experiments that will transform the very way of life of our country and its citizens."
- Michael Steele at the National Press Club, July 20, 2009
"There are many loyal American men and women who believe that this bill, inspired by foreign experiments in Communism, and backed by the radical forces in this country, strikes at the heart of our American civilization..."
Mary Kilbreth, then well-known anti-suffragist, hammered out the words above in a letter to President Harding in a feeble attempt to derail the Sheppard-Towner Act (STA). At that point STA was the mother of all health-care reforms.
The League of Women Voters, 1920s.
With the mission of "instruction of expectant mothers in pre- and post-natal care, federal aid to states, hospital care and visiting nurses," it was precipitated by sobering statistics provided by the Roosevelt-convened Children's Bureau: in 1918 there were 23,000 maternal deaths, an increase of 43% just two years prior. Roughly 250,000 infants died each year, and compared to other industrialized countries the U.S. ranked 17th in maternal health and 11th in infant mortality. Worse yet, a family's socioeconomic status dictated different outcomes.
According to Stanley Lemon’s Woman citizen social feminism in the 1920s, one in six babies are dying in families making less than $450 annually, while only one in sixteen died for those families making over $1,250 annually.
Something had to be done. Women's organizations, victorious in their battle a year prior to pass the 19th amendment securing a woman's right to vote, overwhelmingly supported STA. They lobbied legislators, begged for President Harding's support and threatened those who planned to vote against it.
President Warren G. Harding at Walter Reed Hospital, 1921.
And the fear that reverberated through Congress was palpable and appropriate. There wasn't any accurate count as to how extensive the women's vote was and therefore how damaging it could be to a legislator's reelection - it was a "brand new" electorate.
Republican legislators looked to Harding for wisdom that he ultimately didn't possess. They were all too quick to shout a robotic proclamation: "I am an organization republican and await instructions." Harding's language wasn't any more elegant or personable - he wasn't planning on saying anything, just waiting to see whatever Congress had decided.
The medical establishment supported STA by a healthy majority. One group that had lost it's appetite for pesky progressivism was the American Medical Association who called the bill an "Imported socialistic scheme." (Lemons)
Ultimately, STA passed by a wide margin of 63-7. During the seven years the act was law (it was permanent law but required appropriation after 7 years, which it was unable to receive and thus was not implemented after that point) maternal health saw monumental achievements: the maternal death rate decreased from 67 per 1000 to 62; the infant death rate decreased from 75 per 1000 to 64; and 2978 prenatal care centers were created. (Lemons)
What can today's reformers learn and implement from this?
For one, victories while hard fought for aren't permanent. Feminists were instrumental in building a consensus of everyday women who bombarded Congress with letters of support for the bill's passage and threats of reprisals if it saw defeat. Democrats should avoid including in current legislation "sunset" provisions that serve as expiration dates or a requirement for continued appropriations such as the STA required.
So how would costs be controlled if Congress wasn't revisiting how much to fund the program every so often?
Recently, President Obama has suggested that instead of Congress setting Medicare reimbursement rates (which vary sometimes drastically from region to region because legislators look out for their constituent businesses) an independent panel should. This would standardize reimbursement and root out inefficiencies and overtreatment of the kind Atul Gawande, noted surgeon and journalist, recently wrote about at length.
Second, while consensus is apparent among the public, with 54% approving of legislation currently being drafted in Congress, according to the Washington Post, consensus is weakening in Congress. Blue Dog Democrats, self-labeled moderates, have threatened to derail current legislation due to the possibility it'll either lead to higher deficits or taxes, in the form of a surcharge on the wealthy (individuals making $280,000 and above) that House bills currently peg at between 1%-5.4%.
On the other hand, the Blue Dogs are being somewhat disingenuous because there are only two ways for the government to pay for something - collect additional tax revenue or borrow the money and increase the deficit. If the Blue Dogs support neither then they really don't support the principle - "PAYGO" rules - they have espoused for years. Such rules clamp down on deficit spending by requiring new legislation, programs, or government spending to be offset by increased revenue (i.e., additional taxes) or by cutting spending elsewhere.
President Obama, Surgeon General Dr. Regina Benjamin, and HHS Secretary Kathleen Sebelius.
With 60 votes in the Senate and 256 in the House, Democrats only need a consensus among themselves to make health-care reform legislation a reality. But are the Blue Dogs aware of the reprisals that await them if they tank health care?
Democrats could stand to learn a lesson from their fellow GOP legislators. When Republicans were the majority in Congress during Bush's second term in office they "threatened severe retribution for fellow Republicans who balk at casting a desired party vote, hitting them in two important goals: reelection and status in the Congress," according to political science researchers and professors William and Carol Weissert.
Lastly, the opposition to STA wasn't successful because Republicans lacked a coherent and plausible message buttressed by leadership support. Reformers can fall into that same trap if they aren't careful. Obama has delegated responsibilities to Congress liberally (no pun intended) and at this critical juncture he can afford to no longer. And while his rhetoric has strengthened and public appearances have increasingly focused on health care, acute pressure must be placed upon Congress.
It's too late to attempt to increase public support - especially when the public is close to 50/50 on the issue and legislators feel they can vote either way and be in the clear. They must know that if they don't support it that there will be consequences. Obama campaigned on providing universal insurance, and as Sen. Lindsey Graham recently said in regard to the majority party in power getting what it wants, "[E]lections have consequences."