1. Schorr, Thelma BSN, RN, FAAN


Same spat, different day.


Article Content

In may the American Medical Association (AMA) announced it will oppose creation of a new government-sponsored health insurance plan and that health services should be provided through private markets, as they currently are. In June, the AMA's new president suggested expanding the Federal Employee Health Benefit Program (FEHBP) as a public option. But the FEHBP is merely a program of managed competition by private insurers and not a public option at all.


As Yogi Berra might put it, "It's deja vu all over again."


Debates about a national health insurance program have been simmering for a century. In 1912 Theodore Roosevelt's Progressive Party's platform called for "the protection of home life against the hazards of sickness, irregular employment and old age through the adoption of a system of social insurance. . . ." Soon thereafter, the American Association for Labor Legislation formed a Committee on Social Insurance, which included prominent members of the AMA. The committee produced a compulsory plan covering the majority of workers. The AMA, which had originally called the plan "the inauguration of a great social movement," rapidly changed course and has consistently opposed mandatory health insurance ever since.


In 1927 Calvin Coolidge appointed a Committee on the Cost of Medical Care, which documented the severe problems Americans faced in trying to obtain and pay for medical care. That committee called for a plan to provide care through group practice, paid for by insurance or taxation. The AMA called the plan "socialism and communism, inciting to revolution."


On August 14, 1935, Franklin Roosevelt signed the Social Security Act into law. Health insurance was excluded. It would take three more decades of zealous arguments before Medicare and Medicaid became law, enacted as part of Lyndon Johnson's Great Society programs.


As might have been expected, the AMA and the American Nurses Association (ANA) took different positions throughout the years of congressional discourse on health insurance.

Figure. Thelma Schor... - Click to enlarge in new windowFigure. Thelma Schorr

The Forand Bill (1958), a forerunner of today's Medicare, had testifying for it the ANA, the AFL-CIO, the National Farmers Union, the Group Health Association, the American Public Welfare Association, and the National Association of Social Workers. Opposing it were the AMA, the National Chamber of Commerce, the National Association of Manufacturers, the Health Insurance Association of America, the Pharmaceutical Manufacturers' Association, and the American Farm Bureau Federation.


To be fair to physicians, among the voices that have been added to the discussion in the decades since 1958 are Physicians for a National Health Program (in 1987) and Doctors for America (in 2008), both supporting health care reform.


Looking at that 1958 lineup and at the argument today, it would be easy to say that those on the other side are thinking only of the bottom line and their wallets and that we on our side are thinking about the patients. Well, isn't it true? In the end, it's not a matter of just looking at what other countries have done or figuring out the costs. Shouldn't the start of our discussion be an agreement that it is shameful that millions of Americans don't have access to basic health care? The private health care industry has operated since the beginning of our nation and hasn't solved that problem. Now it's time (about time, really) to try a different approach and make it our national responsibility to take care of each other's health and well-being.


On February 5, in an op-ed in the Washington Post, Barack Obama wrote that "in America, our destiny isn't written for us but by us. We can place good ideas ahead of old ideological battles, and a sense of purpose above the same narrow partisanship. We can act boldly to turn crisis into opportunity and, together, write the next great chapter in our history and meet the test of our time." Sounds good to me.