At last: a National Health Care Reform Bill!
For me and many of colleagues, passing a national health care reform bill is the culmination of a long process. In the late 1950s and early 60s, when I was going to medical school in Chicago, Canada’s Tommy Douglas was beginning a national health care plan in the province of Saskatchewan. As I came to the end of my medical training, doctors began to strike in Canada because they didn't want to practice medicine under any system that was not totally free enterprise in nature. But as a new physician at the time, it seemed to me that the benefits of extending health coverage to everyone in Canada far outweighed the benefits a free enterprise system. Between 1963 and 1970, while I got my training in adult and child psychiatry and served two years in the United States Navy, I had the opportunity to observe the American healthcare “nonsystem” firsthand. Every day, I watched as people fell through the cracks. When I entered politics in the Washington state legislature, I knew that it was my obligation to do all that I could to bring about a national system that would provide coverage for everyone. And during my campaign for governor in 1972, I made my first speech declaring my support for a single-payer system similar to Canada. Each year that I served in the state legislature, I faced the institutional resistance to the creation of a more orderly system. Yet people complained they couldn't get care. Hospitals complained about uncompensated care. People complained about cost shifting of the expenses of the uninsured onto the policies paid for by the insured.
In the early 1980s, I began trying to establish an uncompensated care fund that would be paid into by all hospitals and the receipts would be given to those hospitals that took care of those in the community who had no health insurance. But hospitals resisted. I did a study to find out how many people in the state of Washington either were not covered by a government program or didn't have insurance through their employment. Unsurprisingly, we found that it was a huge number. So In 1983, I began the process of trying to do in Washington State what Tommy Douglas had done a few hundred miles away in the province of Saskatchewan.
As I tried to get universal coverage in the state of Washington, I ran into numerous obstacles. The medical establishment was more interested in capital investments than they were in ensuring that medical coverage was available to everyone in Washington. Large businesses were reluctant to accept any responsibility beyond what they were already doing for their employees. Any mandate was out of the question because under a technical loophole, big employers are exempt from many regulations that deal with insurance. So instead, I ended up authoring the Washington State Basic Health Plan, which is a subsidized health insurance program to help lower-income families afford coverage. But I wasn’t able to get universal coverage.
This experience taught me that it was going to be incredibly difficult to create a health care plan in one state that could be replicated across the country as had been done in Canada. I wrote the plan originally when the governor of the state of Washington was a Republican, so it didn’t get anywhere until Democrat Booth Gardner was elected governor of Washington in 1984. The process was so frustrating and the final legislation so modest that I decided I'd go back to medicine. I went to work for the State Department in Africa where I saw the beginnings of the AIDS epidemic in 1987.
One day my brother called me when I was in Africa and told me there was a seat open in Congress. He suggested that I return to the U.S. to run for the seat and work on getting universal health care. The dream was not dead, it has just been dormant. So I returned, ran for Congress and was elected in 1988. I made the decision to get on the Ways and Means Committee because I thought that was where I could be most effective in getting a national plan established. I was appointed to the committee in 1991 and began working with 95 other members who were dedicated to a single player plan. In 1993 President and Mrs. Clinton came to Washington to enact a national health plan, but we were unsuccessful.
The years between 1994 and 2006 were a painful period as we watched Republicans try to dismantle the only national health care program we have, Medicare. We breathed a great sigh of relief at the 2008 election of President Barack Obama who stated that he wanted to enact a national health plan. The President was determined not to repeat the errors of the Clinton administration, and the process of writing the bill has been a long and tortuous. Over the course of many months, we’ve watched this bill wind through three committees in the House and 2 committees in the Senate, which brought us to where we are today.
I still believe that a single-payer model is the most effective to achieve both cost control and universal coverage. But 40 years of experience prevent me from being ideological about the solution to the problems of universal coverage. Rather than establishing a single-payer system, Congress has designed a less desirable model that that would more tightly regulate private insurance companies much in the same way that we do with utility companies. Members of Congress have opted for a model that provides for insurance regulation at the national level, rather than the state level as it is today. It has much in common with the French system which provides universal coverage to the French people at half the cost of what we spend here in the United States. Their system provides a quality of care that is considered the best in the world according to the World Health Organization.
I know that this bill is far from perfect and will require continued efforts to adjust and improve it in the years to come. But today we began. As the Chinese adage says, “every journey of 1000 miles begins with a single step.” We have taken that step.
Congressman Jim McDermott