Reflections: Medical care

Several weeks ago, my wife spent a few days in McCullough-Hyde Memorial Hospital with a serious infection. Once diagnosed, I’m glad to say that she recovered quickly and was home in time for Thanksgiving. We are fortunate to have good insurance, and so this illness, once put to rest, did not cost us a fortune, but it made me stop and reflect on the need for insurance which has often been woefully lacking in the United States.

Medical care has always cost a good deal of money. For many years, as I was growing up, the American Medical Association (AMA) aggressively opposed any kind of national insurance program.

There was a call for some kind of national program in the immediate aftermath of World War II. Medical exams for military service had revealed that an extraordinary number — about 30% of all Americans — were unfit for military service because of physical or mental disability. To remedy that situation, after the war ended, President Harry S. Truman proposed a national health care program in a message to Congress. That proposal went nowhere.

The AMA opposed that suggestion then and for years thereafter. During the Cold War, when anything that seemed remotely related to communism was suspect, so-called “socialized medicine” didn’t have a chance.

People continued to call for health care reform in the years that followed. The insurance industry prospered, as did the medical profession, but more and more Americans were uninsured, and a serious illness could lead to homelessness or worse.

Bill Clinton wanted to do something about the situation when he became President in 1993, and he called aggressively for health care reform. One speech to Congress was particularly powerful, and Clinton launched a project, headed by his wife, Hillary Rodham Clinton, to draft a proposal for reform. 

She made a fundamental mistake. With a small band of advisers, she produced a creative plan, but she never let people know what she was doing. Plus, she never shared her ideas with the Congress, which was going to have to act on any proposal put forward. The initiative was dead in the water.

So things stood until Barack Obama became President in 2009. With Democratic majorities in both houses of Congress in his first term, Obama pushed successfully for passage of the Affordable Care Act, known colloquially as Obamacare.

That effort has worked spectacularly well. As of January 2024, 21.3 million people signed up for insurance under Obamacare, more than 5 million more than the year before, and now about 45 million people are covered. Some people are still left out, to be sure, but the program has done a superb job in making health insurance available to those who didn’t have it before.

And yet the program has faced ferocious opposition from Republicans, who have led dozens of efforts to kill the program. None of those has succeeded, but some challenges were close. Indeed, it was only John McCain’s vote in the Senate in August 2018 that saved the program at all.

But now the threat of elimination, or at the very least serious cutting, is greater than ever before. The new administration, about to take power in January, will be filled with people — notably Robert F. Kennedy, Jr., Donald Trump’s nominee for Secretary of Health and Human Services — who oppose such federal policies.  During the campaign, Trump himself spoke about a “concept” for revising Obamacare, but to this day details remain unclear.

My wife, mercifully, recovered from her illness and hospitalization. We can only hope that our nation’s premier insurance program will do the same.

Allan Winkler is a University Distinguished Professor of History Emeritus at Miami University, where he taught for three decades. He serves on the Board of Directors for the Oxford Free Press.