History of health care reform in the United States

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Health care reform in the United States
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The issue of health insurance reform in the United States has been the subject of political debate since the early part of the 20th century. Recent reforms remains an active political issue. Alternative reform proposals were offered by both of the two major candidates in the 2008 presidential election.

Contents

[edit] Federal reform efforts

[edit] 19th century

One of the earliest health care proposals at the federal level was the 1854 Bill for the Benefit of the Indigent Insane, which would have established asylums for the indigent insane, as well as the blind, deaf, and dumb, via federal land grants to the states. This bill was proposed by activist Dorothea Dix, which passed both houses of congress, but was vetoed by president Franklin Pierce. Pierce argued that the federal government should not commit itself to social welfare, which he believed was properly the responsibility of the states.[1][2]

Pierce's veto was seen as a landmark in social welfare legislation in the United States, the veto establishing federal non-participation in social welfare for over 70 years, until the New Deal legislation of the 1930s, in the context of the Great Depression.[3]

[edit] 1900s-1920s

Letter from President Harry Truman defending his Fair Deal proposal for a national compulsory health insurance program.[4]

In the first 10–15 years of the 20th century Progressivism was influencing both Europe and the United States.[5] Many European countries were passing the first social welfare acts and forming the basis for compulsory government-run or voluntary subsidized health care programs.[6] The United Kingdom passed the National Insurance Act of 1911 that provided medical care and replacement of some lost wages if a worker became ill. It did not, however, cover spouses or dependents. U.S. efforts to achieve universal coverage began with Theodore Roosevelt, who had the support of progressive health care reformers in the 1912 election but was defeated.[7] Progressives campaigned unsuccessfully for sickness insurance guaranteed by the states.[8] A unique American history of decentralization in government, limited government, and a tradition of classical liberalism are all possible explanations for the suspicion around the idea of compulsory government-run insurance.[6] The American Medical Association (AMA) was also deeply and vocally opposed to the idea.[8] In addition, many urban US workers already had access to sickness insurance through employer-based sickness funds.

Early industrial sickness insurance purchased through employers was one influential economic origin of the current American health care system.[9] These late 19th century and early 20th century sickness insurance schemes were generally inexpensive for workers: their small scale and local administration kept overhead low, and because the people who purchased insurance were all employees of the same company, that prevented people who were already ill from buying in.[9] The presence of employer-based sickness funds may have contributed to why the idea of government-based insurance did not take hold in the United States at the same time that the United Kingdom and the rest of Europe was moving toward socialized schemes like the UK National Insurance Act of 1911.[9] Thus, at the beginning of the 20th century, Americans were used to associating insurance with employers, which paved the way for the beginning of third party health insurance in the 1930s.

[edit] 1930s-1950s

With the Great Depression, more and more people could not afford medical services. In 1933, Franklin D. Roosevelt asked Isidore Falk and Edgar Sydenstricter to help draft provisions to Roosevelt's pending Social Security legislation to include publicly funded health care programs. These reforms were attacked by the American Medical Association as well as state and local affiliates of the AMA as "compulsory health insurance." Roosevelt ended up removing the health care provisions from the bill in 1935. Fear of organized medicine's opposition to universal health care became standard for decades after the 1930s.[10]

During this time, individual hospitals began offering their own insurance programs, the first of which became Blue Cross.[11] Groups of hospitals as well as physician groups (i.e. Blue Shield) soon began selling group health insurance policies to employers, who then offered them to their employees and collected premiums. In the 1940s Congress passed legislation that supported the new third-party insurers. During World War II, Henry Kaiser used an arrangement in which doctors by passed tradition fee-for-care and were contracted to meet all the medical needs for his employees on construction projects up and down the West coast.[12] After the war ended, he opened the plan up to the public as a non-profit organization under the name Kaiser Permanente.

Following the second world war, President Harry Truman called for universal health care as a part of his Fair Deal in 1949 but strong opposition stopped that part of the Fair Deal.[13][14] However, in 1946 the National Mental Health Act was passed, as was the Hospital Survey and Construction Act, or Hill-Burton Act. In 1951 the IRS declared group premiums paid by employers as a tax-deductible business expense,[6] which solidified the third-party insurance companies' place as primary providers of access to health care in the United States.

[edit] 1960s-1980s

In the Civil Rights era of the 1960s and early 1970s, public opinion shifted towards the problem of the uninsured, especially the elderly. Since care for the elderly would someday affect everyone, supporters of health care reform were able to avoid the worst fears of "socialized medicine," which was considered a dirty word for its association with communism.[6] After Lyndon B. Johnson was elected president in 1964, the stage was set for the passage of Medicare and Medicaid in 1965.[15] Johnson's plan was not without opposition, however. "Opponents, especially the AMA and insurance companies, opposed the Johnson administration's proposal on the grounds that it was compulsory, it represented socialized medicine, it would reduce the quality of care, and it was 'un-American.'"[6] These views notwithstanding, the Medicare program was established by legislation signed into law on July 30, 1965, by President Lyndon B. Johnson. Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are either age 65 and over, or who meet other special criteria.

In the late 1960s and early 1970s, the predominant public opinion was one that espoused ideals of universal coverage.[16] In 1968 a National Opinion Research Center poll reported that 87 percent of Americans believed that health care was a right of all American citizens.[5] This popular feeling was further elaborated by academics of the time. In 1972, two Princeton economists, Herman Somers and Anne Somers, evaluated all the proposals in front of Congress related to achieving universal coverage. They laid out a series of criteria for a successful and "effective national health insurance," the first of which was this: "Universal coverage of the resident population without distinction as to income or premium contributions. The undertaking of national health insurance is justified by the recognition that access to medical care is a necessity, not a luxury, and that universal protection is required. Universality cannot be achieved by voluntarism, even when supported by incentives. Publicly imposed means tests are destructive to universality and, when accompanied by a separate program for means tests eligibility, almost always lead to a double standard and a 'two-class' quality of care. One of the objectives of a national system must be to end such discrimination."[17]

In his 1974 State of the Union address, President Richard M. Nixon called for comprehensive health insurance.[18] On February 6, 1974, he introduced the Comprehensive Health Insurance Act. Nixon's plan would have mandated employers to purchase health insurance for their employees, and provided a federal health plan, similar to Medicaid, that any American could join by paying on a sliding scale based on income.[19][20] The New York Daily News wrote that Ted Kennedy rejected the universal health coverage plan offered by Nixon because it wasn't everything he wanted it to be. Kennedy later realized it was a missed opportunity to make major progress toward his goal.[21]

Even a moment of near ideological consensus in the United States was not enough to practically advance universal coverage any further. By the late 1970s, with concern over rapidly rising health care costs[22] and the defeat of the last-ditch concession Kennedy-Mills bill, the idea of universal coverage had fallen flat.[5] Former President Jimmy Carter wrote in 1982 that Kennedy’s disagreements with Carter's proposed approach thwarted Carter’s efforts to provide a comprehensive health-care system for the country.[23]

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) amended the Employee Retirement Income Security Act of 1974 (ERISA) to give some employees the ability to continue health insurance coverage after leaving employment.

[edit] Clinton initiative

See also: Health Security Express

Health care reform was a major concern of the Bill Clinton administration headed up by First Lady Hillary Clinton; however, the 1993 Clinton health care plan was not enacted into law. COBRA made it easier for workers to keep health insurance coverage when they change jobs or lose a job[citation needed], and also provided national standards for protecting personal health information.

The "Health Security Express" was a bus tour that started the end of July 1994. It involved supporters of President Clinton's national health care reform. Several buses leaving from different points in the United States, such as Portland, Oregon, and Boston, Mass crossed the country and stopped in many cities along their way to their final destination at the White House in Washington, DC on August 3, 1994. During these stops, each of the bus riders would talk about their personal experiences, health care disasters and why they felt it was important for all Americans to have health insurance.[24] When the Health Security Express bus tour ended, all of the riders were greeted by President Clinton and the First Lady on the White House South lawn for a rally on Wednesday, August 3, 1994 which was broadcast all over the world by many international networks including C-SPAN.[25]

[edit] Bush era debates

In 2000 the Health Insurance Association of America (HIAA) partnered with Families USA and the American Hospital Association (AHA) on a "strange bedfellows" proposal intended to seek common ground in expanding coverage for the uninsured.[26][27][28]

In 2001, a Patients' Bill of Rights was debated in Congress, which would have provided patients with an explicit list of rights concerning their health care. This initiative was essentially taking some of ideas found in the Consumers' Bill of Rights and applying it to the field of health care. It was undertaken in an effort to ensure the quality of care of all patients by preserving the integrity of the processes that occur in the health care industry.[29] Standardizing the nature of health care institutions in this manner proved rather provocative. In fact, many interest groups, including the American Medical Association (AMA) and the pharmaceutical industry came out vehemently against the congressional bill. Basically, providing emergency medical care to anyone, regardless of health insurance status, as well as the right of a patient to hold their health plan accountable for any and all harm done proved to be the biggest stumbling blocks for this bill.[29] As a result of this intense opposition, the Patients' Bill of Rights initiative eventually failed to pass Congress in 2002.

As president, Bush signed into law the Medicare Prescription Drug, Improvement, and Modernization Act which included a prescription drug plan for elderly and disabled Americans.[30]

During the 2004 presidential election, both the George Bush and John Kerry campaigns offered health care proposals. Bush's proposals for expanding health care coverage were more modest than those advanced by Senator Kerry.[31][32][33] Several estimates were made comparing the cost and impact of the Bush and Kerry proposals. While the estimates varied, they all indicated that the increase in coverage and the funding requirements of the Bush plan would both be lower than those of the more comprehensive Kerry plan.[34][35]

In 2006 the HIAA's successor organization, America's Health Insurance Plans (AHIP), issued another set of reform proposals.[36]

In January 2007 Rep. John Conyers, Jr. (D-MI) has introduced The United States National Health Care Act (HR 676) in the House of Representatives. As of October 2008, HR 676 has 93 co-sponsors.[37] Also in January 2007, Senator Ron Wyden introduced the Healthy Americans Act (S. 334) in the Senate. As of October 2008, S. 334 had 17 cosponsors.[38]

Also in 2007, AHIP issued a proposal for guaranteeing access to coverage in the individual health insurance market and a proposal for improving the quality and safety of the U.S. health care system.[39][40]

"Economic Survey of the United States 2008: Health Care Reform" by the Organisation for Economic Co-operation and Development, published in December 2008, said that:[41]

  • Tax benefits of employer-based insurances should be abolished.
  • The resulting tax revenues should be used to subsidize the purchase of insurance by individuals.
  • These subsidies, "which could take many forms, such as direct subsidies or refundable tax credits, would improve the current situation in at least two ways: they would reach those who do not now receive the benefit of the tax exclusion; and they would encourage more cost-conscious purchase of health insurance plans and health care services as, in contrast to the uncapped tax exclusion, such subsidies would reduce the incentive to purchase health plans with little cost sharing."

In December 2008, the Institute for America's Future together with the chairman of the Ways and Means Health Subcommittee Pete Stark launched a proposal from Jacob Hacker who is co-director of the U.C. Berkeley School of Law Center on Health that in essence said that the government should offer a public health insurance plan to compete on a level playing field with private insurance plans.[42] This was said to be the basis of the Obama/Biden plan. The argument is based on three basic arguments. Firstly public plans success at managing cost control (Medicare medical spending rose 4.6% p.a. compared 7.3% for private health insurance on a like-for-like basis in the 10 years from 1997–2006). Secondly public insurance has better payment and quality-improvement methods based on its large databases, new payment approaches, and care-coordination strategies. Thirdly it can set a standard against which private plans must compete which would help unite the public around the principle of broadly shared risk while building greater confidence in government over the long term.[43]

Also in December 2008, America's Health Insurance Plans (AHIP) announced a set of proposals which included setting a national goal to reduce the projected growth in health care spending by 30%. AHIP said that if this goal were achieved, it would result in cumulative five-year savings of $500 billion. Among the proposals was the establishment of an independent comparative effectiveness entity that compares and evaluates the benefits, risks, and incremental costs of new drugs, devices, and biologics.[44] An earlier "Technical Memo" published by AHIP in June 2008 had estimated that a package of reforms involving comparative effectiveness research, health information technology (HIT), medical liability reform, "pay-for-performance" and disease management and prevention could reduce U.S. national health expenditures "by as much as 9 percent by the year 2025, compared with current baseline trends."[45]

[edit] Debate in the 2008 presidential election

Main article: Health care reform in the United States presidential election, 2008

Both of the major party presidential candidates offered positions on health care.

John McCain's proposals focused on open-market competition rather than government funding. At the heart of his plan were tax credits - $2,500 for individuals and $5,000 for families who do not subscribe to or do not have access to health care through their employer. To help people who are denied coverage by insurance companies due to pre-existing conditions, McCain proposed working with states to create what he called a "Guaranteed Access Plan."[46]

Barack Obama called for universal health care. His health care plan called for the creation of a National Health Insurance Exchange that would include both private insurance plans and a Medicare-like government run option. Coverage would be guaranteed regardless of health status, and premiums would not vary based on health status either. It would have required parents to cover their children, but did not require adults to buy insurance.

The Philadelphia Inquirer reported that the two plans had different philosophical focuses. They described the purpose of the McCain plan as to "make insurance more affordable," while the purpose of the Obama plan was for "more people to have health insurance."[47] The Des Moines Register characterized the plans similarly.[48]

A poll released in early November, 2008, found that voters supporting Obama listed health care as their second priority; voters supporting McCain listed it as fourth, tied with the war in Iraq. Affordability was the primary health care priority among both sets of voters. Obama voters were more likely than McCain voters to believe government can do much about health care costs.[49]

[edit] 2009 reform debate

Main article: Health care reform debate in the United States

In March 2009 AHIP proposed a set of reforms intended to address waste and unsustainable growth in the current health care market. These reforms included:

  • An individual insurance mandate with a financial penalty as a quid pro quo for guaranteed issue
  • Updates to the Medicare physician fee schedule;
  • Setting standards and expectations for safety and quality of diagnostics;
  • Promoting care coordination and patient-centered care by designating a "medical home" that would replace fragmented care with a coordinated approach to care. Physicians would receive a periodic payment for a set of defined services, such as care coordination that integrates all treatment received by a patient throughout an illness or an acute event. This would promote ongoing comprehensive care management, optimizes patients’ health status and assist patients in navigating the health care system
  • Linking payment to quality, adherence to guidelines, achieving better clinical outcomes, giving better patient experience and lowering the total cost of care.
  • Bundled payments (instead of individual billing) for the management of chronic conditions in which providers would have shared accountability and responsibility for the management of chronic conditions such as coronary artery disease, diabetes, chronic obstructive pulmonary disease and asthma, and similarly
  • A fixed rate all-inclusive average payment for acute care episodes which tend to follow a pattern (even though some acute care episodes may cost more or less than this).[50]

On May 5, 2009, US Senate Finance Committee held hearings on Health care reform. On the panel of the "invited stakeholder", no supporter of the Single-payer health care system was invited.[51] The panel featured Republican senators and industry panelists who argued against any kind of expanded health care coverage.[52] The preclusion of the single payer option from the discussion caused significant protest by doctors in the audience.[52]

There is one bill currently before Congress but others are expected to be presented soon. A merged single bill is the likely outcome.[citation needed] The Affordable Health Choices Act is currently before the House of Representatives and the main sticking points at the markup stage of the bill have been in two areas; should the government provide a public insurance plan option to compete head to head with the private insurance sector, and secondly should comparative effectiveness research be used to contain costs met by the public providers of health care.[citation needed] Some Republicans have expressed opposition to the public insurance option believing that the government will not compete fairly with the private insurers. Republicans have also expressed opposition to the use of comparative effectiveness research to limit coverage in any public sector plan (including any public insurance scheme or any existing government scheme such as Medicare), which they regard as rationing by the back door.[citation needed] Democrats have claimed that the bill will not do this but are reluctant to introduce a clause that will prevent, arguing that it would limit the right of the DHHS to prevent payments for services that clearly do not work.[citation needed] America's Health Insurance Plans, the umbrella organization of the private health insurance providers in the United States has recently urged the use of CER to cut costs by restricting access to ineffective treatments and cost/benefit ineffective ones. Republican amendments to the bill would not prevent the private insurance sectors from citing CER to restrict coverage and apply rationing of their funds, a situation which would create a competition imbalance between the public and private sector insurers.[citation needed] A proposed but not yet enacted short bill with the same effect is the Republican sponsored Patients Act 2009.[citation needed]

On June 15, 2009, the U.S. Congressional Budget Office (CBO) issued a preliminary analysis of the major provisions of the Affordable Health Choices Act.[53] The CBO estimated the ten-year cost to the federal government of the major insurance-related provisions of the bill at approximately $1.0 trillion.[53] Over the same ten-year period from 2010 to 2019, the CBO estimated that the bill would reduce the number of uninsured Americans by approximately 16 million.[53] At about the same time, the Associated Press reported that the CBO had given Congressional officials an estimate of $1.6 trillion for the cost of a companion measure being developed by the Senate Finance Committee.[54] In response to these estimates, the Senate Finance Committee delayed action on its bill and began work on reducing the cost of the proposal to $1.0 trillion, and the debate over the Affordable Health Choices act became more acrimonious.[55][56] Congressional Democrats were surprised by the magnitude of the estimates, and the uncertainty created by the estimates has increased the confidence of Republicans who are critical of the Obama Administration's approach to health care.[57][58]

However, in a June New York Times editorial, economist Paul Krugman argued that despite these estimates universal health coverage is still affordable. "The fundamental fact is that we can afford universal health insurance--even those high estimates were less than the $1.8 trillion cost of the Bush tax cuts."[59]

In contrast to earlier advocacy of a publicly-funded health care program, in August 2009 Obama administration officials announced they would support a health insurance cooperative in response to deep political unrest amongst Congressional Republicans and amongst citizens in town hall meetings held across America.[60][61][62] However, in a June 2009 NBC News/Wall Street Journal survey, 76% said it was either "extremely" or "quite" important to "give people a choice of both a public plan administered by the federal government and a private plan for their health insurance."[63]

During the summer of 2009, members of the "Tea Party" protested against proposed health care reforms.[64][65][66] Former insurance PR executive Wendell Potter of the Center for Media and Democracy- whose funding comes from groups such as the Tides Foundation-[67] argue that the hyperbole generated by this phenomenon is a form of corporate astroturfing, which he says that he used to write for CIGNA.[68] Opponents of more government involvement, such as Phil Kerpen of Americans for Prosperity- whose funding comes mainly from the Koch Industries corporation[69] counter-argue that those corporations oppose a public-plan, but some try to push for government actions that will unfairly benefit them, like employer mandates forcing private companies to buy health insurance.[70] Journalist Ben Smith has referred to mid-2009 as "The Summer of Astroturf" given the organizing and coordinating efforts made by various groups on both pro- and anti-reform sides.[66]

[edit] State and city reform efforts

A few states have taken serious steps toward universal health care coverage, most notably Minnesota, Massachusetts and Connecticut, with recent examples being the Massachusetts 2006 Health Reform Statute[71] and Connecticut's SustiNet plan to provide quality, affordable health care to state residents.[72] The influx of more than a quarter of a million newly insured residents has led to overcrowded waiting rooms and overworked primary-care physicians who were already in short supply in Massachusetts.[73] Other states, while not attempting to insure all of their residents, cover large numbers of people by reimbursing hospitals and other health care providers using what is generally characterized as a charity care scheme; New Jersey is perhaps the best example of a state that employs the latter strategy.

Several single payer referendums have been proposed at the state level, but so far all have failed to pass: California in 1994,[74] Massachusetts in 2000, and Oregon in 2002.[75] The state legislature of California has twice passed SB 840, The Health Care for All Californians Act, a single-payer health care system. Both times, Governor Arnold Schwarzenegger (R) vetoed the bill, once in 2006 and again in 2008.[76][77][78]

The percentage of residents that are uninsured varies from state to state. Texas has the highest percentage of residents without health insurance at 24%.[79] New Mexico has the second highest percentage of uninsured at 22%.[79]

States play a variety of roles in the health care system including purchasers of health care and regulators of providers and health plans,[80] which give them multiple opportunities to try to improve how it functions. While states are actively working to improve the system in a variety of ways, there remains room for them to do more.[81]

One municipality, San Francisco, California, has established a program to provide health care to all uninsured residents (Healthy San Francisco).

In July 2009, Connecticut passed into law a plan called SustiNet, with the goal of achieving health-care coverage of 98% of its residents by 2014.[72] The SustiNet law establishes a nine-member board to recommend to the legislature, by January 1, 2011, the details of and implementation process for a self-insured health care plan called SustiNet. The recommendations must address (1) the phased-in offering of the SustiNet plan to state employees and retirees, HUSKY A and B beneficiaries, people without employer-sponsored insurance (ESI) or with unaffordable ESI, small and large employers, and others; (2) establishing an entity that can contract with insurers and health care providers, set reimbursement rates, develop medical homes for patients, and encourage the use of health information technology; (3) a model benefits package; and (4) public outreach and ways to identify uninsured citizens.[82] The board must establish committees to make recommendations to it about health information technology, medical homes, clinical care and safety guidelines, and preventive care and improved health outcomes. The act also establishes an independent information clearinghouse to inform employers, consumers, and the public about SustiNet and private health care plans and creates task forces to address obesity, tobacco usage, and health care workforce issues. The effective date of the SustiNet law was July 1, 2009 for most provisions.[82]

In May of 2011, the state of Vermont became the first state to pass legislation establishing a Single-Payer health care system. The legislation, known as Act 48, establishes health care in the state as a "human right" and lays the responsibility on the state to provide a health care system which best meets the needs of the citizens of Vermont. The state is currently in the studying phase of how best to implement this system.

[edit] See also

[edit] References

  1. ^ Pierce, Franklin (May 3, 1854). "Veto message". Livonia, Mich.: LONANG (Laws Of Nature And Nature's God) Institute. http://www.lonang.com/exlibris/misc/1854-pvm.htm. Retrieved March 22, 2010. 
  2. ^ Tiffany, Francis (1890). The life of Dorothea Lynde Dix. Boston: Houghton Mifflin. p. 180. ISBN 0217963579. OCLC 251005. 
  3. ^ Manning, Seaton W. (March 1962). "The tragedy of the Ten-million-acre bill". Social Service Review 36 (1): 44–50. doi:10.1086/641182. 
  4. ^ Truman, Harry S. (April 12, 1949). "Letter from Harry S. Truman to Ben Turoff". College Park, Md.: National Archives and Records Administration. http://arcweb.archives.gov/arc/action/ExternalIdSearch?id=201512. Retrieved December 2, 2011. 
    • Truman, Harry S.; Poen, Monte M. (ed.) (1982). Strictly personal and confidential: the letters Harry Truman never mailed. Boston: Little, Brown. pp. 96–97. ISBN 0316712213. 
  5. ^ a b c Derickson, Alan (2005). Health security for all: dreams of universal health care in America. Baltimore: Johns Hopkins University Press. ISBN 0801880815. 
  6. ^ a b c d e Patel, Kant; Rushefsky, Mark E. (2006). Health care politics and policy in America (3rd ed.). Armonk, N.Y.: M.E. Sharpe. pp. 34–74. ISBN 0765614782. 
  7. ^ Igel, Lee (May–June 2008). "The history of health care as a campaign issue". Physician Executive 34 (3): 12–15. PMID 18605264. http://net.acpe.org/MembersOnly/pejournal/2008/MayJun/Igel.pdf. Retrieved March 11, 2009. 
  8. ^ a b Walker, Forrest A. (Winter 1979). "Americanism versus sovietism: a study of the reaction to the Committee on the Costs of Medical Care". Bulletin of the History of Medicine 53 (4): 489–504. PMID 397839. 
  9. ^ a b c Murray, John E. (2007). Origins of American health insurance: a history of industrial sickness funds. New Haven: Yale University Press. ISBN 0300120915. 
  10. ^ Coombs, Jan (2005). The rise and fall of HMOs: an American health care revolution. Madison: University of Wisconsin Press. pp. 5–6. ISBN 0299202402. http://books.google.com/books?id=tK71nX5LxSEC&pg=PA5. Retrieved May 31, 2009. 
  11. ^ Sultz, Harry A.; Young, Kristina M. (2011). Health care USA: understanding its organization and delivery (7th ed.). Sudbury, Mass.: Jones & Bartlett Learning. pp. 35–37, 230–232. ISBN 0763784583. 
  12. ^ Falkson, Joseph L. (1980). HMOs and the politics of health system reform. Chicago: American Hospital Association. ISBN 0872582884. 
  13. ^ Geselbracht, Raymond H. (1999). "The Truman administration during 1949: a chronology, part two". Independence, Mo.: Harry S. Truman Library and Museum. http://www.trumanlibrary.org/chron/49chron2.htm#fair. Retrieved October 7, 2009. 
    In 1949, as part of his Fair Deal:
    • On April 24, 1949 The American Medical Association denounced this health program.
    • On April 25, 1949 The Murray-Dingell omnibus health legislation (S.1679 and H.R. 4312) were introduced into the Senate and the House; the Congress adjourned in October 1949 without acting on these bills.
  14. ^ Poen, Monte M. (1979, 1996). Harry S. Truman versus the medical lobby: the genesis of Medicare. Columbia: University of Missouri Press. pp. 161–168. ISBN 0826210864. 
  15. ^ Falk, I.S. (Winter 1973). "Medical care in the USA—1932–1972. Problems, proposals and programs from the Committee on the Costs of Medical Care to the Committee for National Health Insurance". Milbank Memorial Fund Quarterly. Health and Society 51 (1): 1–32. JSTOR 3349608. PMID 4579461. 
  16. ^ Sabo, Martin Olav (Winter 1978). "National health insurance and the states". Publius 8 (1): 55–62. JSTOR 3329629. PMID 11675749. 
  17. ^ Somers, Herman M.; Somers, Anne R. (April 1972). "Major issues in national health insurance". Milbank Memorial Fund Quarterly 50 (2 Part 1): 177–210. JSTOR 3349444. PMID 4628239. 
  18. ^ Nixon, Richard (January 30, 1974). "Address on the State of the Union delivered before a Joint Session of the Congress". In Woolley, John T.; Peters, Gerhard (eds.). The American Presidency Project. Santa Barbara: University of California, Santa Barbara. http://www.presidency.ucsb.edu/ws/index.php?pid=4327. Retrieved December 3, 2009. 
  19. ^ Himmelstein, David U; Woolhandler, Steffie (op-ed) (December 15, 2007). "I am not a health reform". The New York Times: p. A23. http://www.nytimes.com/2007/12/15/opinion/15woolhandler.html. Retrieved December 3, 2009. 
  20. ^ Hall, Kevin G. (November 28, 2007). "Democrats' health plans echo Nixon's failed GOP proposal". Washington, D.C.: McClatchy Washington Bureau. http://www.mcclatchydc.com/226/story/22163.html. Retrieved December 3, 2009. 
  21. ^ Sisk, Richard (August 26, 2009). "Health care reform was Sen. Ted Kennedy's unfinished life's work". Daily News (New York). http://www.nydailynews.com/news/politics/2009/08/27/2009-08-27_health_care_reform_was_sen_ted_kennedys_unfinished_lifes_work.html. Retrieved March 13, 2010. 
  22. ^ Falk, I.S. (Spring 1977). "Proposals for national health insurance in the USA: origins and evolution, and some perceptions for the future". Milbank Memorial Fund Quarterly. Health and Society 55 (2): 161–191. JSTOR 3349642. PMID 406581. 
  23. ^ Carter, Jimmy (1982). Keeping faith: memoirs of a President. New York: Bantam Books. pp. 86–87. ISBN 0553050230. 
  24. ^ Fisher, Mary Jane (August 1, 1974). "'Health Security Express' prods Congress for reform". National Underwriter. Property & casualty/risk & benefits management ed. 98 (31): 4–5. ISSN 1042-6841. http://www.amazon.com/Health-Security-Express-Congress-reform/dp/B00092L9YU. Retrieved October 30, 2010. 
  25. ^ . (August 3, 1994). "Health Security Express (video 43:26)". Washington, D.C.: C-SPAN. http://www.c-spanvideo.org/program/59243-1. Retrieved October 30, 2010. 
  26. ^ . (November 20, 2000). "'Strange bedfellow' join forces on agreement for uninsured Americans (press release)". Washington, D.C.: Families USA. http://www.familiesusa.org/resources/newsroom/press-releases/2000-press-releases/press-release-strange-bedfellows-join-forces-on-agreement-for-uninsured-americans.html. Retrieved June 19, 2009. 
  27. ^ Kahn III, Charles N.; Pollack, Ronald F. (January–February 2001). "Building a consensus for expanding health coverage". Health Affairs 20 (1): 40–48. doi:10.1377/hlthaff.20.1.40. PMID 11194859. http://content.healthaffairs.org/content/20/1/40.full.pdf. Retrieved June 19, 2009. 
  28. ^ Meier, Conrad F. (April 1, 2001). "HIAA and Families USA seek more government". Chicago: The Heartland Institute. http://www.heartland.org/publications/health%20care/article/682/HIAA_and_Families_USA_Seek_More_Government.html. Retrieved June 19, 2009. 
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