A 2009 rally in which advocates of a single-payer health care system gathered in Burlington, Vt. (AP Photo/Toby Talbot)

The mind continues to boggle at the fact that House Republicans have actually shut down the federal government in an attempt to prevent the expansion of affordable healthcare to millions of vulnerable Americans. But corporate and conservative opposition to universal coverage has existed since the 1930s, when many supported including national health insurance in the Social Security Act and Senator Robert F. Wagner of New York proposed what we would now call Medicare-for-all. Campaigns to defeat what Nation contributor Leonard Robins called in 1978 “the last great unfinished piece of welfare legislation envisioned in Roosevelt’s New Deal” have always been backed by untold sums of corporate money and marked by a notably consistent streak of red-baiting rhetoric and doom-saying predictions.

In “Who Fights Health Insurance?” (June 23, 1945), the journalist Geraldine Sartain wrote about the efforts of the administration of Harry Truman to resurrect the pre-war national health insurance proposals, and the fierce opposition from industry:

The battle against health insurance is on again, this time characterized by several new developments. The most important of these are the advertising campaigns promoted by the organized medical profession in its last-ditch stand against what it calls “socialized medicine.”

Sartain noted that the American Medical Association had taken out six paid advertisements urging newspaper and magazine editors to

tell the American people what perils await them: that their “priceless heritage,” the private-enterprise system, is endangered; that “the sacred relationship between doctor and patient” is similarly threatened (no mention is made of the millions of our people who have virtually no relationship with doctors, sacred or otherwise, because they haven’t the money to pay for it); that “the sanctity of human personality” will be undermined; that doctors are “to be regimented and made subordinate to the bureaucrat, and the people forced by law to accept such medical care as could be provided by a politically appointed bureaucrat.”

The advertising campaign added that national insurance would be “a fatal step toward complete totalitarian control over the lives and destinies of all men.” Sound familiar?

Forty-eight years later, as another new Democratic president struggled to reform healthcare so as to provide universal coverage, The Nation’s Washington editor David Corn wrote in “Big Players vs. Single-Payer” (April 26, 1993) about the efforts by the insurance industry and the AMA to derail single-payer proposals, then enjoying 70 percent approval among the American people.

The realists among the single-payer activists are trying to figure out how to nudge whatever plan arises from the White House closer to their ideal. It won’t be easy. In the frenzy of lobbying to come, they must spark public cries of support that can be heard above the special interest din and scare the hell out of legislators.

Later on, pro-single-payer members of Congress will have to decide where to draw the line. The President’s plan—what-ever it is eventually dubbed—may address some of their de­mands, and single-payer legislators may be able to shape the bill during the debate in Congress. But at some point they may face the question, Is the prevailing reform worth their votes? Should they settle for, say, managed competition with univer­sal access, cost controls and a decent minimum-benefits package as the best that can be achieved at this time?

Nothing will be decided soon. Revamping one of the largest sectors of the U.S. economy will not happen fast—it may not even happen this year, if it happens at all. The political sys­tem can confront such a heavy reform job only once every few decades; it would be nice if Washington got it right the first time. But the probable outcome is halfway reform that does not challenge too profoundly the prerogatives of the power­ful. If after that Americans still perceive the health care sys­tem to be in crisis, the single-payers may get their shot.

The Clintons, of course, proved tragically receptive to the campaign against single-payer and the reform effort went down in flames. Four years ago, the movement for single-payer healthcare faced even stronger headwinds and President Obama eventually dropped even the “public option” that, perhaps not coincidentally, enjoyed the same 70 percent support level among Americans as the single-payer plan had sixteen years earlier and was called “needed but…by no means sufficient” by this magazine. Yet even the highly compromised Affordable Care Act produced hysterical cries of socialism and death panels—and now an across-the-board government shutdown—from the same crew that has been making the same baseless, fear-mongering arguments for the past eighty years. As for the future time when Corn predicted universal health insurance might actually be tried, all we can say is: hasten the day.


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