When President Lyndon Johnson proposed Medicare to provide medical coverage for the elderly in the 1960s, it was opposed by small-government conservatives, the American Medical Association (AMA), and others who called it socialized medicine.
Yet, Medicare quickly became so embedded in American society that it is considered an untouchable “third rail” that politicians dare not openly oppose. But the forces that opposed it then remain and resurface when healthcare reform is on the agenda.
The Pew Research Center reports that a majority of Americans believe the federal government is responsible for making sure all Americans have healthcare coverage. However, examined more closely, there is a clear partisan bias in the results: 88% of Democrats say the federal government is responsible for making sure all Americans have healthcare coverage; 66% of Republicans say it isn’t.
The Affordable Care Act (ACA) is a clear example of this ideological divide. Throughout our history, Americans have tended to look to the federal government to address systemic problems like access to healthcare, and the ACA targets one specific aspect of the problem – uninsured and underinsured Americans. Democrats supported the ACA. Despite the fact that the ACA is based on free-market principles and is modeled on a conservative plan adopted in Massachusetts under a Republican governor, Republicans in the US Congress were united in opposing its passage and have persistently sought to undermine its effectiveness. And despite promises, no equally effective Republican alternative has yet been proposed.
This failure to offer viable alternatives leaves open the question: If the federal government is not allowed to solve the problem, what organization or group is in a position to do so?
Typically, proposed reforms that threaten healthcare industry interests provoke fierce opposition.
Last year, the pharmaceutical sector alone spent more on lobbying than any other industry. Hospitals and professional organizations are also big spenders. There were eight lobbyists for each member of Congress working to influence health reform bills in 2009. In the end, the American Medical Association successfully lobbied to have the following provisions removed from the ACA:
- $300 yearly fee for doctors who participate in Medicare or Medicaid
- tax on cosmetic surgery
- 5% Medicare payment cuts to the top 10% of Medicare billers
Today, the Partnership for America’s Health Care Future, a lobbying group founded by organizations including the Blue Cross Blue Shield Association and the AMA (which has since exited), are fighting Medicare For All.
Lack of contact with the medical system
About 80% of healthcare dollars are spent on about 20% of the population.
In any given year, most people will not need anything but the most basic healthcare, meaning that a majority of people avoid significant interaction with the healthcare system. Only a minority will need urgent, expensive, or hard-to-access care. As a result, there is limited political pressure to fix urgent problems.
“That really has been working in favor of the status quo,” explains Simon F. Haeder, a healthcare policy expert and assistant professor at Penn State University. “If we all experienced how shady the system is in any given year, then we’d all ask for a lot of changes.”