An Analytical View of the Changing Face of Universal Healthcare in America

In our system of government that provides for the basic rights and freedoms of humans, how can we avoid providing for the most fundamental of our needs? The need to establish a universal, compulsory system of federal healthcare in America is mounting daily. Soaring costs and ineffective administrations have caused a great deal of turmoil within the American healthcare system. The time to push solid healthcare legislation through will come with the upcoming presidential election. As a society, we are ready for dramatic reform in Washington and the opportunity awaits us.

In analyzing the need for a federally funded healthcare system, one must consider the history of the issue from its fundamental precepts. Legislation supporting nationally subsidized health insurance has existed since the turn of the twentieth century. However, nearly all early optimistic efforts in favor of creating such a system met tough criticism and were subject to a biased and financially conservative post-depression population. President Franklin D. Roosevelt argued that he was strongly in favor of sustaining a mentally and physically healthy nation. However, he was unwilling to risk the potential failure of the Social Security Act of 1935 as a whole to include any statutes establishing compulsory healthcare. Thus began the fight for the implementation of a system of national healthcare in America.

It was not until the re-election of President Harry Truman in 1948 that any viable measures to establish a multilateral system were introduced and seriously evaluated in the eyes of the American society and Congress. Following the path of history, strong opposition existed against the advancement of any legislation enacting subsidized healthcare through the government. Entangled in the anticommunist Cold War effort, society was not ready to support any form of "socialized medicine" modeled after communist entities. The Truman administration approached the situation with a different perspective than Franklin Roosevelt's administration. Unlike the original plan, which proposed a separate plan for the less fortunate members of society, Truman proposed an egalitarian, or universal, system that covered all citizens. Unfortunately, this plan was met with a Republican Congress in 1946 and was quickly shot down and dismissed as unnecessary and unconstitutional.

It is important to take into consideration the proceedings of the past to help shape the future of healthcare in America. It is clear that legislation that proposes such holistic effects must find a support base on both sides of the political aisle. Human rights should not be a partisan issue in our country. Societies all over the world have taken the initiative to provide for the basic well-being of their members. As the most wealthy and powerful nation on the planet, we have no logical excuse, excluding pure lack of concern, to not follow in their footsteps.

The trend leading to modern healthcare has proved a consistently rising need for government subsidies. Over time, we have invested more and more into a faulty system that operates on a backward curve forcing millions of American citizens to endure preventable illnesses unnecessarily. Not only is this fiscally irresponsible; producing billions of dollars of deficit annually, it violates our most basic right to life as United States citizens. In 1993, a decade and a half ago, nearly 14% of the national budget was appropriated to healthcare programs. Even then, we knew that we would soon face issues with our failing federal healthcare system. In 2008, over 35% of the domestic budget was appropriated to the same system that is now producing results far worse than even those in the early 1990's. (Clymer.Pear,Toner [NY Times] "The Health Care Debate: What went wrong?".) We have to wake up to the reality of the healthcare crisis facing America or we will face insurmountable deficits and an ailing population.

In a modern global perspective, it has become a generally accepted principle that every citizen retains the basic right to universal healthcare. Every developed and industrialized nation in the world, except the United States, has implemented some form of compulsory health insurance coverage for all of its citizens. All efforts to establish such a system in America have failed due to a plethora of intervening special interest groups, lobbyists, and dissenting congressional representatives. The culmination of these influences has rendered the vast majority of proposed legislation dead on arrival. The demonstrated need for federal assistance exists in the homes of over forty-seven million uninsured Americans. (U.S Census "Income,Poverty, and Health Insurance Coverage in the United States")

It is this path of American history that has left our system of healthcare in its current state. Our modern system of providing public healthcare is both inefficient and ineffective. Although the United States spends more per capita on healthcare each fiscal year than any other nation in the world, over forty-seven million Americans remain uninsured. This staggering statistic is the direct result of the inapt and overly complex system that exists today. Upon close examination of the federal Medicare and Medicaid systems, one can easily see how overwhelming administrative costs have undermined the basic care and well-being of all United States citizens. Over sixty-one million Americans ranging in age from nineteen to sixty-four remain uninsured or are systematically uninsured due to exposure to high premiums and substandard care. (The Commonwealth Fund "Insured but not protected") In an effort to provide for the concerns and conditions of the day, we have methodically compromised the inherent needs of the people.

In response to the unyielding rate of healthcare premium inflation, many states have created "quasi-national" healthcare plans and implemented them throughout their jurisdiction. State and municipal organizations, such as MassHealth, TennCare, and Medi-Cal were established to combat the economic suppression imposed by the current federal system. Although these systems have assisted millions of people, they lack both the funding and political support to address all needs that arise within their command.

Support from all levels of government, from local and municipal officials to federal bureaucrats and congressional representatives, is imperative to the establishment of any progressive healthcare legislation. As can be observed thought the history of progress in American politics, multilateral and bipartisan support yields regulation that is far more effective than unilateral, dogmatic stabs at change. We must cooperate across party lines and across the boundaries of faith and moral standards to ascertain the common right to health in America. Such is the precedent of alteration set by those who have paved the way to modern politics and thus this is how we must proceed if we wish to gain any sustainable ground.

As in any case, it is logistically necessary to evaluate the full spectrum of effects a given piece of federal legislation may impose if enacted. While the statistics are often interpreted in favor of establishing universal healthcare, we must also evaluate the situation holistically. Some concerned citizens have argued that healthcare is not a right under the 10^th amendment and that the government has no authority to mandate or establish any system which would impose coverage upon people who did not want it or wish to finance it though taxation. Others argue that if everyone had equal access to health services, wait times at medical facilities would increase dramatically which would lead to a sharp increase in deaths from neglect.

The Emergency Medical Treatment and Active Labor Act (EMTALTA), which was passed in Congress in 1986 requires that every patient who seeks emergency care at a medical facility be provided necessary treatment regardless of their ability to pay, citizenship, or legal standing. Some say that this legislation provides enough protection and serves as a safety net for those who cannot afford to pay for medical services. Moreover, some argue against the basic principles that are presented by those in favor of universal healthcare. While supporters rave of reduced paperwork and increased doctor-patient interaction, other dissent that increased bureaucratic oversight would further complicate the process and effectively slow the process to an even further extent. Critics of the proposed system often cite the fact that establishing the proposed system would increase the cost to operate businesses in the Unites States since the legislation would entail extensive tax increases for both businesses and individuals.

However, several arguments suggest that establishing a federal system would significantly improve the quality of healthcare in our nation. Studies conducted by the Cato Institute suggest that since over 60% of the United States' healthcare system is already publicly funded directly through employers, taxation would actually reduce the cost that employers and individuals would pay out of pocket. Physicians for National Health Program (PNHP) "Won't this raise my taxes?") Furthermore, the three largest car manufacturers in the United States have consistently reported that the current healthcare system places such a burden on them that it forces them to add approximately $900 to $1400 to each car they sell. (Guardian.co.eu"Detriot's Big Three seek White House help.") This is a direct refutation to the assumption that a federalized system would be an

additional cost and restraint on businesses since, in actuality, such a system would replace direct payments with reasonable taxation; thus removing the burden of healthcare from America's businesses and their customers. By eliminating the inefficiency within our healthcare system, we would effectively reduce administrative costs and reduce the inept delivery of medical attention directly to patients.

It is also reasonable to argue that up to 60% of American doctors and other various medical professionals support the idea of forming a system of universal healthcare. In a recent survey conducted by Reuters that interviewed 2,000 U.S. Doctors, 83% of psychiatrists and 69% of emergency medicine specialists support the current proposed healthcare legislation. (Reuters "Doctors support universal healthcare: Survey") With equal healthcare for all citizens, we guarantee the availability of proper medical treatment to every citizen. Under the current system, many people face the choice of whether they want to be treated for a condition or provide for their families. This is unacceptable and should be handled with utmost priority in Congress.

One major controversy surrounding the current system of federal healthcare is the division of benefits granted based upon age and those provided based upon income. Currently, Medicare handles affairs that deal with the elderly population and their medical needs by subsidizing part of their cost if they qualify, while Medicaid handles cases involving financial need and/or abnormal family circumstances. Criticism of both system suggests that total healthcare reform is in order.

Under a system of universal healthcare through the government, both social and ethnic minorities would receive equal access to professional medical treatment. This eliminates the need for a two-step, two-program system and maintains the aspects of unity and equality that are proposed through current theories and potential solutions. Thus, by establishing compulsory healthcare nationwide, we are providing a basis for social equality and equal opportunity to every American who seeks it. Standardization provides impartial freedoms to everyone by guaranteeing one's right to the fundamentals of American citizenship.

Several attempts to establish federal healthcare throughout history have proved catastrophic failures. As mentioned, the cumulative interests of small groups and/or individual organizations have always hindered the progression of binding regulation. Lobbyists have gained overwhelming influence in the legislature over time. Often armed with unlimited resources, organizations can persuade congress to vote in their favor by offering generous bribes disguised as "campaign contributions". Such a scenario existed following the introduction of President Clinton's Health Security Act in 1993. Lobbyists played a major role in destroying the legislation submitted by theTask Force on National Health Care Reform before it was even drafted or had made it to the floor of the congressional houses.

However, the Clinton Administration had one definitive advantage over all previous propositions. The special interest groups were clearly divided on the issue. Discrepancies existed in the leadership of major lobbyist organizations therefore opening the door for persuasion by either side of the argument. Theoretically, this was the perfect time to introduce legislation, since the largest organization that could potentially oppose it, the American Medical Association, was suffering from low membership levels and executive conflicts. At the time, the AMA only represented 41% of the medical community. (Arron,Henry J. 122) This was not enough to claim that their interests were inline with those of the entire medical profession. Therefore, in many senses, the Clinton Administration had an excellent opportunity to play their executive cards correctly to get the Health Safety Act passed.

Although the Clinton Administration was a champion of major legislation proposals, they were not always the most delicate stewards of it. What Hillary Clinton and her task force failed to account for was that in Congress, the actual bill is only half of an uphill battle. The way you present and promote that bill differentiates between success and failure. Naïve to this fact, the task force imposed their plan and assumed it would find success in Congress due to its bipartisan appeal. However, opposition arose and so began the decline of the legislation that ultimately led to its demise.

As mentioned, the American Medical Association (AMA) was divided on the issue originally. Those in favor of the act quickly lost ground to those who touted the fact that the organization stood to loose significant profits if the system of reform passed. Specific mandates within the language of the bill placed caps on the amount a doctor or other medical professional could charge to provide a service. This limit was placed to prevent doctors from gauging prices and making incomprehensible profits at the expense of the American people. Naturally, Dr. James S. Todd, executive vice president of the AMA at the time, filtered millions of dollars into lobbying Congress to prevent the passing of the reformation regulation. In a historical turn around, the legislation failed just as quickly as it had gained popularity.

Amidst the litigation proposed against the 1993 legislation, the American Federation of Labor and Congress of Industrial Organizations (AFL-CIO), the largest federation of unions in the United States, spent millions to campaign in support of the bill. The legislation proposed by the Clinton Administration was inline with their standards of healthcare. Members of the unions, which the organization represented, were strongly in favor of establishing affordable healthcare on a national scale. The organization made failing attempts to counteract the extensive spending of the AMA. Although they rallied some support, speculation about the complexity of the bill had already caused key interest groups, such as the American Association for Retired People (AARP), to shy away from extending their support to the bill.

This move was a fatal blow to the Health Security Act as a whole. The AMA had successfully arisen sufficient speculation about the long-term effects of the bill, rendered it hopeless in a sea of questions. Despite attempts from both Hillary and Bill Clinton to express their flexibility to change and openness to alter specific language within the bill, a majority of interest groups rallied to reject the legislation as a whole. Hillary Clinton was quoted stating that the legislation had been "constructed to be deconstructed" and that the legislation "was described as an ultimatum by our opponents and therefore used to undermine the process of reaching agreement." (Clymer [NY Times] g"Hillary Clinton Says Administration Was Misunderstood on Health Care") Groups such as the Chamber of Commerce and the Business Roundtable, whose support was key to the success of the act, moved in clear support of the AMA. The Republican leadership in Congress took a strong stance against the bill, which ended the Clinton's hard-fought campaign for universal healthcare in America.

The aforementioned scenario is yet another instance in which Congress was significantly influenced to cater to the desires of the "highest bidder". The public must turn our current "congressional auction house" back into a representative body of the people, by the people, and for the people if we wish to pass effective legislation to establish healthcare for every American citizen. We cannot function as a representative democracy while the influence of the few mandates that of the majority. Just as the need to establish consistent, reliable, and affordable healthcare for every citizen exists now, the time to act is now. We must take valiant strides to initiate reform across partisan boundaries to realize true success.

The former chair of the Task Force on National Health Care Reform in the early 1990's, First Lady Hillary Clinton, realized that her failed approach and assertive method led to the ultimate demise of the legislation in Congress. In 2005, she was quoted stating, "I learned some valuable lessons about the legislative process, the importance of bipartisan cooperation and the wisdom of taking small steps to get a big job done." Although the Clinton Administration failed to accomplish their ultimate goal of providing healthcare for every American, they set an important precedent for the future.

On January 20, 2007, Senator Hillary Clinton formally announced her candidacy for President of the United States. She also announced that her wealth of healthcare knowledge, which she had championed while her husband was President, would be put into use to create a multilateral, bipartisan system of universal healthcare. Building upon that which had already been universally accepted, she suggested a cooperative measure to establish the effective and efficient system that had been speculated about for over a decade. This system effectively renewed the public's interest in federal healthcare and sparked the torch of further investigation. Although Senator Clinton recently suspended her campaign for President of the United States, she left behind the spirit and atmosphere for catastrophic reform in America. As she so eloquently stated in her recent concession speech, "Although we weren't able to shatter that highest, hardest glass ceiling this time, thanks to you, it's got about 18 million cracks in it. And the light is shining through like never before, filling us all with the hope and the sure knowledge that the path will be a little easier next time. That has always been the history of progress in America." (Clinton [transcription] "Hillary's Remarks in Washington on June 7")

With all aspects of the argument included, one can safely deduce that America is ready for the implementation of an effective compulsory system of universal healthcare. However, the need for assistance does not leave when legislation escapes the hands of congressional representatives. We must keep the ball moving until someone scores in our favor. We must not let our failures and weak points prevent us from moving forward with sweeping legislation.

Now is not the hour for idleness, now is the moment and opportunity for change. As Hittel declared centuries ago, "If not now, when? If not us, who?" By recognizing the history of the issue and working progressively it is feasible to end the battle for healthcare. By supporting candidates who recognize the urgent crisis at hand and are prepared to act upon it, citizens can brighten the horizon of healthcare in America.

"Every moment wasted looking back keeps us from moving forward."

-Hillary Clinton, June 7, 2008

(Clinton [transcription] "Hillary's Remarks in Washington on June 7")