100 Years of Healthcare Reform (Pt 1)

A history of American Healthcare Reform.

Society Evolves. We are no more defined in any moment by our obligation to neighbor and community than any moment is defined by the continual and exponential advancement of technology sustained since the beginning of the Industrial Revolution. The United States declared independence only 240 years ago. Our first president passed after doctors performed the then still-popular treatment of blood-letting 216 years ago. These changes through time are more than cosmetic; and each time we’ve been faced with the knowledge or capacity to do better by each other, progress has prevailed.


Political will is not exempt from the forces of inertia. Yet these inertial forces hold equal weight over changes to the processes of political maneuvering. This allows us to look back through our legislative history and pick out themes that help us understand and predict the outcome of current events.

Blood-letting has seen its day come to an end – but the exponential progress of medical advancement far outpaces our legislative capacity to adapt. Not because we couldn’t write a new law tomorrow, but from those thematic inertial forces. Two hundred years later, legislative inaction kills more than practitioner ignorance.

As activists we have to learn why. We have to identify where, how, and with whom we can make the greatest impact. The greatest activists took action with a deep respect for the importance of history in shaping those actions. Below is your crash course of health care reform – and the potential paths forward it offers.

FDR & The First Safety Net

The Politics of Depression

Black Tuesday marred the stock market in 1929. It offered an exclamatory punctuation to a decade of decadence and widespread proliferation of debt-spending by average Americans. After the markets came the banks – under-insured, unregulated banks falling under the stress of run after run. Credit froze and life-savings vanished as President Herbert Hoover too slowly realized the extent of the need for governmental action. Franklin Roosevelt didn’t win the election in November 1932 – he won it the moment he beat Al Smith on the 4th ballot of the Democratic National Convention.History_FDR_on_Liberation_of_Rome_Speech_SF_still_624x352

Many presidents have tried and failed to recreate what would become known as “The First 100 Days.” They lacked the single-most direct way to break the inertial forces of politics – urgency. Heartland farms succumbed to the dustbowl as rustbelt factories from Detroit to New York ended production. The average American family was no longer guaranteed a reliable income for their next meal. It was FDR’s political career on the line to fix it, and congress, fearing retribution from the American people, would give him almost anything.

The Power of Popular Support

There were two forces at play: FDR was given a mandate to govern through his margin of victory in the 1932 election, and the coattails of his victory gave his party command of Congress – many of whom owed their victory to FDR’s popularity. The immediate urgency to act, FDR’s personal popularity, and a congress controlled by what would become known as “The New Deal Coalition” made it impossible for his political enemies to outvote him or industry representatives the clout to sway him. A man so popular he’d become the only president to serve more than two terms, and use that popularity to pass bank insurance, unemployment insurance, social security, and formally legalize union membership.

Many of these reforms mirrored similar socialist reforms occurring in Europe – with one glaring exception.

The Item Last In Line

The priority – understandably – was to put people back to work. Unemployment reached one-in-four, and effected far more. To put people back to work, businesses needed credit – so bank insurance, now the FDIC, was passed. To make sure people could feed their families until they found work, unemployment insurance and what became our welfare system was created. To create fare wages once factories opened, the Wagoner Act was passed legalizing union membership. The elderly needed to know if they put their money in banks it couldn’t disappear once they were too old to work – so social security was born.image of FDR

These were controversial even for their time. But the urgency for action, the speed of implementation, and the feeble position of the political opposition allowed for them to become our institutions. The one victory by the opposition was the successful removal of one provision to the social security bill. That group was the American Medical Association, and that provision was universal health care.

Many argue FDR intended to revisit health care. But as time progressed he faced increasing opposition to his programs by the Supreme Court, continued economic woes at home, and eventually World War II. President Truman would attempt it shortly after the war as a part of his Fair Deal, but he was not extended the same loyalty by Congress or Americans, and what would become known as the “Do Nothing Congress” blocked his efforts.


Written by Eric Chast

Part Two will be coming shortly.

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