July 30, 2009

Coffee Cup Politics

44 years ago today the Federal government received the first application for enrollment in the Social Security Supplementary Medical Insurance Program, known as Medicare Part B. The applicant was former President Harry S. Truman, and his application was approved by President Lyndon Johnson at the signing ceremony for the bill that created the program.

Harry Truman was at that ceremony for good reason. 20 years earlier it was Truman who sent a message to Congress asking for legislation that would establish a national health insurance plan. Then as now, it was Republicans raising the specter of "socialized medicine" that doomed the idea in its entirety, but by the end of Truman's administration a new plan had been formed and was gaining ground. Truman backed off from the idea of universal coverage, instead focusing on the idea of a program aimed at insuring Social Security beneficiaries, which would include the elderly and the disabled. 20 years of debate ensued with some astonishingly familiar tactics employed by the usual list of suspects.

Operation Coffeecup

The intractable opposition of the AMA and other pressure groups made universal health care an unrealistic goal, so Truman’s Federal Security Administrator, Oscar Ewing, in 1952 began advocating medical care for the aged. Truman hoped that scaling back the ambitious idea of universal health care would mollify the conservative opposition.

It didn’t work. In 1952 the first bill was introduced in Congress to create a Medicare program. The AMA immediately announced its opposition and worked tirelessly and successfully to prevent any such program from advancing in the Congress. The bill withered on the vine. Another bill was introduced in 1958, and the AMA mobilized a massive campaign against it, quintupling its anti-Medicare lobbying budget. Republicans, responding to AMA pressure, bottled the bill up in committee.

The battle waged on, with labor siding with the Democrats and raising the ante for the AMA funded Republicans. In 1960 Senator Robert Kerr (D-OK) and Representative Wilbur Mills (D-AR) proposed a compromise. The Kerr-Mills bill created a state-based welfare program covering only the medically indigent and the elderly on state welfare rolls. This scaled-back scheme was enacted into law in September 1960. The plan would be entirely optional for the states. If a state so chose, they were free to ignore the law. Even this pitiful compromise was bitterly resisted by the AMA, but there was enough popular support that even the AMA’s money couldn’t buy enough votes to defeat it.

In the subsequent political battles over Medicare, the AMA would deploy an alternative strategy; developing an alternative they labeled “Eldercare.” This scheme was essentially Kerr-Mills on steroids, promising more generous benefits than Medicare, but still limiting the benefits to the welfare population rather than to all elderly Social Security beneficiaries. However, the non-indigent elderly were still in need of health care coverage and still unlikely to be able to purchase it in the marketplace. Studies at the time reported that the elderly used medical services at a rate twice that of those younger; that three-fifths of the elderly had less than $1,000 in liquid assets; and that nearly 54% lacked any form of health insurance. It was clear to virtually everyone that the elderly had medical-care problems that far exceeded those of the average American.

The election of John F. Kennedy added new pressure to the push for Medicare and advocates were optimistic that the 1961-62 session of Congress would see some improvement, but Medicare was by no means a shoe in, and the AMA remained a significant force of opposition.

Starting in 1961, the 82,000 strong AMA Woman’s Auxiliary (physician’s wives) began a variety of public relations tasks on behalf of their husbands. In the spring of 1961 they launched Women Help American Medicine (WHAM). In promotional material still found in the AMA archives, WHAM bluntly stated their goal as: “This campaign is aimed at the defeat of the King-Anderson bill of the 87th Congress, a bill which would provide a system of socialized medicine for our senior citizens and seriously curtail the quality of medical care in the United States.”

So the first specter of socialism was raised in 1961 by the AMA. This was the public face of their efforts, but there was another component to the AMA campaign. This side depended on hiding AMA involvement from congress. It was called Operation Coffeecup, and it also involved the Woman’s Auxiliary. It is also where former President Ronald Reagan got his toe in the political door.

The AMA had commissioned Reagan to make a recording of a speech demonizing Medicare. Reagan did such a good job that the term “Socialized Medicine” has entered the American lexicon as a virtual synonym for any government assisted healthcare.

“[I]f you don’t [stop Medicare] and I don’t do it, one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.

The AMA Women’s Auxiliary was to arrange a series of coffee-klatches with key members of Congress. The wives were instructed to downplay the purpose of the meetings, playing them as if some sort of spontaneous neighborhood events. Materials found in the AMA archives state: “Drop a note—just say ‘Come for coffee at 10 a.m. on Wednesday. I want to play the Ronald Reagan record for you.”

The die was cast, and the right has forever hitched their wagon to the notion that government sponsored healthcare is somehow linked to socialism, regardless of the overwhelming evidence to the contrary. The rogue’s gallery is a virtual casting call for wingnuts and hysterical idealism.

In 1964, George H.W. Bush: Described Medicare as “socialized medicine.”

That same year, Barry Goldwater said, “Having given our pensioners their medical care in kind, why not food baskets, why not public housing accommodations, why not vacation resorts, why not a ration of cigarettes for those who smoke and of beer for those who drink.”

Reagan, of course, went on to become President, giving the AMA and other right wing ideologues an ear to bend.

In 1996, Presidential candidate Bob Dole bragged of being one of 12 House members who voted against creating Medicare in 1965. “I was there, fighting the fight, voting against Medicare . . . because we knew it wouldn’t work in 1965.”

In the almost four and a half decades since Medicare was signed into law, the right wing opposition to Medicare has continued unabated. Were it not for overwhelming popular support, those aligned forces would, I’m sure, drive a stake into the program’s heart. As Igor Volsky notes on the Wonk Room blog, conservatives have attempted in the decades since Medicare’s creation to kill it and force it to “wither on the vine.”

Medicare isn’t perfect by any stretch, but it has improved access to health care for the elderly, helped them to live longer, healthier lives, reduced poverty, and has become one of the most popular government programs.

Today we have another ambitious proposal from another President who finds himself the target of right wing fear-mongering and hysteria, much like Truman. The universal healthcare plan proposed by Obama and championed by the Democrats in Congress is flawed just as Medicare is flawed, of that we can be certain. But the fear-inducing hysteria promoted by the same old list of suspects is stirring up the same unjust anxiety it did 50 years ago.

The AMA today is a different organization, but now we have the insurance giants and their lobbyists to worry about. The Republican Congress sounds about the same today as they did in 1945, and today they have FOX, Limbaugh, et al echoing the call. I would hope that students of history would be wary of the sock puppets and make decisions based on reason and fact. One can hope.