Cokie Roberts Answers Your Health Care Questions

Republicans have unveiled a new health care proposal. Commentator and columnist Cokie Roberts answers questions from listeners about the history of politics and health care in the U.S.

STEVE INSKEEP, HOST:

Let's Ask Cokie, as we do each Wednesday, about politics and American political history, how the government works. And today, we're going to ask about health care in the middle of this week of big health care news. Which is nothing new for the United States. Americans have been arguing about national health care since at least the time of President Harry Truman.

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HARRY S. TRUMAN: Then I asked this Congress to do something about the health of the people of this country. I asked them for health insurance. You know, in this country, the people in the middle can't afford to go to a hospital. And they can't afford to pay what it costs sometimes. And they can't afford sometimes even to pay the doctor's bill after they get service.

INSKEEP: That was Harry Truman in 1948. Republicans called it socialized medicine. And the passage of Obamacare in 2010 quite obviously did not end the debate. So what's going on? We've invited your questions. And Cokie Roberts is here to help answer them. Hi, Cokie.

COKIE ROBERTS, BYLINE: Hi, Steve.

INSKEEP: And here's our first question from Iolanthe Rosa. Her question is, did the United States consciously choose not to pursue universal health care after World War II when the rest of the developed world was implementing that?

ROBERTS: Well, as you just heard, President Truman tried to get universal health care. But his plan was incredibly lobbied against. For the first time ever, that much money was spent on lobbying by the American Medical Association, who said that he was following the Moscow party line that health care was the keystone in the architecture of a socialist state.

INSKEEP: This is the beginning of the Cold War, so...

ROBERTS: Right, all of that. And the truth is he didn't have much pushback from the other side because during World War II, there had been wage and price controls. And corporations wanting to woo workers created fringe benefits - health care, retirement plans, all of that.

And the country was highly unionized at the time. And the unions would get health care benefits into their contracts. So they didn't really feel like they needed anything beyond that. Of course, the big problem came for people who weren't working for companies that had health programs and for retirees.

INSKEEP: OK, so didn't work then. The 1960s come, and they did get Medicare and Medicaid but still not national health care. Which gets to our next question from Greg Marshall. What did old folks do before Medicare?

ROBERTS: They depended on savings or their families or charity. But the fight for Medicare was just as vicious. I actually remember this one quite well. Doctors' offices were filled with materials against socialized medicine. But the big difference here was that Lyndon Johnson was president and had had a huge landslide victory in 1964, big Democratic majorities in the House and Senate. And the Republicans split on the subject.

So he was able to get Medicare, health care for the elderly as part of Social Security and Medicaid for the poor to be administered by the states. And it really changed the face of health care in America. As of last year, Steve, 55 million Americans on Medicare and 70 million on Medicaid, many of those added after the expansion of Medicaid from Obamacare.

INSKEEP: Which brings us to another query here from Sarah Eggers, who wants to know, what is the history of states versus the federal government offering or controlling health care funding and distribution?

ROBERTS: Well, states, if they opt into Medicaid, have certain regulations. But they can do their own programs. And many of them do. The truth is that for the federal government, up until Obamacare, it was always something very specific - veterans' health, childrens' health, health for the elderly.

In fact, the very first health care bill was back in 1798, the Act for the Relief of Sick and Disabled Seamen, which is in response to a yellow fever epidemic. And they were required, they were mandated to pay a portion of their salaries to a health care system. It was the first payroll tax. And hospitals were set up by the government in ports.

So that was our very first health care bill. Between then and the passage of the Affordable Care Act, lots of fits and starts, including President Nixon, who had a plan for universal health care that was opposed by the liberals who wanted single-payer. So it's been going on for a very long time, Steve. And here we are again.

INSKEEP: Cokie Roberts, thanks very much.

ROBERTS: Good to be with you.

INSKEEP: And we Ask Cokie your questions each Wednesday morning. You can Ask Cokie using that hashtag - #AskCokie - or email askcokie@npr.org.

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