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Quadagno at the Democratic Senators Issues Conference

Last month, Jill Quadagno was invited to present her take on the US healthcare system, specifically addressing the question ‘why do so many Americans not have healthcare?’, to a group of leading Democratic senators. Prof. Quadagno has graciously allowed us to publish the text of her presentation below.


A few years ago my friend Connie’s husband, Michael, died suddenly of a heart attack at the age of fifty-six. After Michael’s death, Connie found herself struggling not only with her grief but also trying to find an affordable health insurance policy. Because she had had one abnormal pap smear, Connie’s best option was to purchase a major medical policy costing $7,000 a year. Her plan will cover any large health expenses she might incur–after she pays the $3,000 deductible. But the plan carries a clause that if her abnormal pap smear turns into cervical cancer, her health insurance will pay none of the costs. Connie’s story and others, including one of my graduate students who had aged out of his parent’s policy and my own sister who lost her job and health coverage in a bank merger, led me to ask the following questions of health care in America.

How was it, I wondered, that people who experience normal life events–a layoff, widowhood, a serious illness–face the prospect of losing their insurance, being denied care, having their insurer refuse to pay for the health problems they are most likely to have? Why do 46 million Americans have no health insurance?

These were the questions I set out to answer about five years ago. I shuffled through reams of documents in the National Archives, the Library of Congress and various presidential libraries, read many oral histories and interviewed some of the warriors who had been involved in the struggle.

Quadagno_ama_regimentationMy first review of the evidence led me to conclude that the culprit was the American Medical Association. State medical societies worked to defeat government health insurance proposals in the 1910s in New York and California. Then, in the 1940s, the AMA converted medical societies into political machines and created a robust national pr campaign to defeat the national health insurance segment of President Harry Truman’s Fair Deal. Prepared speeches, posters, pamphlets, and cartoons – all AMA publicity derided national health insurance as socialized medicine, part of a Communist plot to destroy freedom and the American way of life.

The AMA also mobilized against Democratic candidates who supported Truman’s plan. Doctors sent personal letters to their patients, explaining that there were “evil forces creeping into this country” and asking them to vote for Republican candidates. They posted notices in waiting rooms asking patients to vote against candidates who supported the Truman plan and even promised to drive them to the polls if they needed a ride. In the 1950 election six Democratic senators who had supported national health insurance were defeated.

Yet, I reflected, was it really possible that the AMA, merely a professional group, could defeat social reformers, powerful politicians and even presidents for more than half a century? The answer is no. Physicians won their battles because they had allies with greater clout and deeper pockets, the Chamber of Commerce, the National Association of Manufacturers, and the big insurance companies like Prudential that were moving into the health insurance market.

AFL-CIO campaign

Quadagno_medicare_picketsignMedicare was finally enacted in 1965 following a decade long AFL-CIO campaign that mobilized trade union members and retirees in every key congressional district. After Medicare, physicians’ antipathy to national health insurance dwindled, tempered by the benefits of guaranteed payment. Now health insurers moved to the forefront of public debates. In the 1980s the Health Insurance Association of America joined with the National Federation of Independent Business to crush a proposal for home care benefits for the disabled.

When President Bill Clinton proposed his plan to guarantee universal health care coverage in 1992, the same coalition of insurers, small business groups and corporations mobilized against him. There was also grassroots opposition from Catholics and other Christians who opposed the inclusion of abortion services.

When I finished my book, I felt very pessimistic. An entire century of defeats. That was then. This is now. Several indicators suggest that business community and the health insurance industry might be more willing to cooperate.

  1. For one there is the Massachusetts plan just enacted, which could be a model for other states.

  2. Equally important is that insurance companies are now deeply embedded in Medicare, which allows beneficiaries to choose a private HMO over traditional fee-for-service benefits, and in Medicaid. Since Florida revised its Medicaid program to give HMOs more options about who to cover, 14 new companies have submitted applications to participate.
  3. Opposition from large companies and manufacturers has eroded as they face the growing costs of paying benefits for current and former employees. GM CEO Rick Wagoner has specifically singled-out employee health care costs as a major factor in his company’s much-publicized recent troubles.

There is also a growing grassroots movement and a broader a constituency for healthcare reform. A quick peek at this constituency indicates that it is also largely the constituency of the Democratic Party.
Constituency for healthcare reform

  1. 77 million baby boomers
    – Half are over 50
    – The first wave has just turned 60

  2. Hispanics
    – 35% of whom have no health insurance
    – Reside in key, battleground states like Florida where over 40% of Hispanic males are uninsured.

  3. Working families in low wage jobs or jobs with small businesses whose vulnerability was revealed in the wake of Hurricane Katrina.

One Nation, Uninsured: Why the U.S. Has No National Health InsuranceUPDATE: University Channel, a very interesting online resource, has Quadagno’s presentation on the same subject delivered at Vanderbilt U. in April. Available as a podcast, HERE.

Jill Quadagno is the Mildred and Claude Pepper Eminent Scholar in Social Gerontology and Professor of Sociology at Florida State University and the author of One Nation, Uninsured: Why the U.S. Has No National Health Insurance.

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