The Wrong Side of History

BY Nicholas D. Kristof
New York Times
18 November 2009

Critics storm that health care reform is “a cruel hoax and a delusion.” Ads in 100 newspapers thunder that reform would mean “the beginning of socialized medicine.”

The Wall Street Journal’s editorial page predicts that the legislation will lead to “deteriorating service.” Business groups warn that Washington bureaucrats will invade “the privacy of the examination room,” that we are on the road to rationed care and that patients will lose the “freedom to choose their own doctor.”

All dire — but also wrong. Those forecasts date not from this year, but from the battle over Medicare in the early 1960s. I pulled them from newspaper archives and other accounts.

Yet this year those same accusations are being recycled in an attempt to discredit the health reform proposals now before Congress. The heirs of those who opposed Medicare are conjuring the same bogymen — only this time they claim to be protecting Medicare.

Indeed, these same arguments we hear today against health reform were used even earlier, to attack President Franklin Roosevelt’s call for Social Security. It was denounced as a socialist program that would compete with private insurers and add to Americans’ tax burden so as to kill jobs.

Daniel Reed, a Republican representative from New York, predicted that with Social Security, Americans would come to feel “the lash of the dictator.” Senator Daniel Hastings, a Delaware Republican, declared that Social Security would “end the progress of a great country.”

John Taber, a Republican representative from New York, went further and said of Social Security: “Never in the history of the world has any measure been brought here so insidiously designed as to prevent business recovery, to enslave workers.”

In hindsight, it seems a bit ridiculous, doesn’t it? Social Security passed, and the republic survived.

Similar, ferocious hyperbole was unleashed on the proposal for Medicare. President John Kennedy and later President Lyndon Johnson pushed for a government health program for the elderly, but conservatives bitterly denounced the proposal as socialism, as a plan for bureaucrats to make medical decisions, as a means to ration health care.

The American Medical Association was vehement, with Dr. Donovan Ward, the head of the A.M.A. in 1965, declaring that “a deterioration in the quality of care is inescapable.” The president of the Association of American Physicians and Surgeons went further and suggested that for doctors to cooperate with Medicare would be “complicity in evil.”

The Wall Street Journal warned darkly in editorials in 1965 that Medicare amounted to “politicking with a nation’s health.” It quoted a British surgeon as saying that in Britain, government health care was “crumbling to utter ruin” and suggested that the United States might be heading in the same direction.

“The basic concerns and arguments were the same” in 1935 against Social Security, in 1965 against Medicare, and today against universal coverage, said Nancy J. Altman, author of “The Battle for Social Security,” a history of the program. (The quotes against Social Security above were taken from that book.)

These days, the critics of Medicare have come around because it manifestly works. Life expectancy for people who have reached the age of 65 has risen significantly. America is no longer shamed by elderly Americans suffering for lack of medical care.

Yet although America’s elderly are now cared for, our children are not. A Johns Hopkins study found that hospitalized children who are uninsured are 60 percent more likely to die than those with insurance, presumably because they are less likely to get preventive care and to be taken to the doctor when sick. The study suggested that every year some 1,000 children may die as a consequence of lacking health insurance.

Why is it broadly accepted that the elderly should have universal health care, while it’s immensely controversial to seek universal coverage for children? What’s the difference — except that health care for children is far cheaper?

Granted, there are problems in the House and Senate bills — in particular, they falter on cost-containment. In the same way, there were many specific flaws in the Social Security and Medicare legislation, but, in retrospect, it’s also clear that they were major advances for our nation.

It’s now broadly apparent that those who opposed Social Security in 1935 and Medicare in 1965 were wrong in their fears and tried to obstruct a historical tide. This year, the fate of health care will come down to a handful of members of Congress, including Senators Joe Lieberman, Blanche Lincoln, Ben Nelson and Mary Landrieu. If they flinch and health reform fails, they’ll be letting down their country at a crucial juncture. They’ll be on the wrong side of history.