HEALTH CARE/Joan Retsinas

Chicken Littles: Relax

The Chicken Littles, a.k.a. the Republican Presidential candidates, are clucking across America–a brood of them, all predicting that the sky, this time, is really going to fall.

The “ifs” roll forth, with Armageddon in sight. If we negotiate with Iran, we will shovel Israelis into ovens. If we don’t stop spending, we will plunge the nation into financial apocalypse. If we don’t deport the immigrants who do the jobs that native-born Americans shun, rapists will run amok in our cities. If we legalize “gay” marriage, we will soon see bestial unions.

Historically, of course, Chicken Little politicians have often predicted that the sky would fall. The culprit: Big Government. An overly zealous Uncle Sam would put the nation on a path to destruction.

On the healthcare front, let me allay the fears of this season’s Chicken Littles with a rehash of instances when Uncle Sam–that dreaded, bumbling oaf–acted decisively. And the sky did not fall. Indeed, the nation thrived.

The Hill Burton Act of 1946

In 1946, to help the many Americans who had worked in the war industry, President Truman proposed national health insurance–anathema to conservatives, including the American Medical Association. The country had private health insurance. The government should stay outside this arena.

Sens. Lister Hill, an Alabama Democrat, and Harold Burton, a Ohio Republican, jointly (cooperation alien to today’s solons) put forth a substitute, a compromise (another alien concept): the government would fund the construction of hospitals throughout the country. By 1948, Uncle Sam had pledged $150 million a year over 4 years – a figure that grew. Overall, Uncle Sam spent $3.7 billion ($21 billion in 2010 dollars) on hospital construction.

The need was dire. During the Depression, the census of private hospitals had fallen. One estimate holds that 800 hospitals closed; 22% of counties had no hospital. Hardest hit were Southern counties. Uncle Sam based the distribution of Hill Burton dollars on population and per capita wealth. Georgia got 76 cents per capita; California, 15 cents per capita. Indeed, the first hospital constructed with Hill Burton funds and a private donor’s gift was in Georgia.

At the same time, Congressional architects added two provisions that today’s Republicans might reject. First, hospitals had to provide “uncompensated care” (many already did, voluntarily – another notion that might befuddle conservatives). Second, hospitals had to admit everybody in their communities, regardless of income, insurance, health status. (For race, the legislation initially allowed separate-but-equal hospitals).

Post Hill-Burton, the country’s hospitals flourished. Critics have wanted more stringent requirements for community service, for uncompensated care. Nobody has wanted to set back the clock.


The law has passed its 50-year mark. At that not-so-long ago birth, one-fourth of Americans over age 65 could not afford medical care; one half had no insurance. Even proponents of work-based insurance could not argue that retirees remain full-time workers until they died, to keep their insurance.

Nevertheless, opponents lined up, again including the American Medical Association. (Ironically, Medicare guaranteed physicians a stream of clients who paid for care.)

Notable politicians entered the fray. Ronald Reagan, not yet President, warned of Soviet socialism creeping into this country, under the umbrella of Medicare. Barry Goldwater decried the bill. So did George H.W. Bush. In the 1980s, when Robert Dole was running for President, he proudly put himself among the bill’s opponents. (“I was fighting … voting against Medicare … We knew it wouldn’t work in 1965.”) After all, Medicare marked a major step for Uncle Sam—stepping into the insurance business. Conservatives were leery.

Nevertheless, pragmatism triumphed. Eighty-three House Republicans (70 in the House, 13 in the Senate) crossed party lines to pass this bill.

Today politicians might propose refashioning Medicare, adding more private insurance plans; but nobody wants to set back the clock. Cataract surgery, hip replacement, cardiac catheterization, hospice—whatever the prescribed treatment—Medicare enrollees can get it.

The Affordable Care Act

The Chicken Littles unanimously promise “Repeal.” They see the Affordable Care Act as a monstrous intrusion into what should be the private sector. Once elected, they promise to send the Act back to Congress for a decisive repeal. They warn that if we don’t repeal it, we will suffer – (though others argue that we would suffer with repeal, as we returned to high percentages of uninsured and underinsured citizens.)

Meanwhile, Congress did pass this law; and to date the sky has not fallen. Enrollees are signing up (the computer glitches got un-glitched); people are getting medical attention; hospitals are getting paid. The Act has drawn complaints: some people are paying more than they did before the Act (ironically, some of those complainers now have more comprehensive coverage). The Act has not yet tamped down overall costs, slated to rise in part because we are an aging population. The Act is not nirvana, but it is a workmanlike way to insure Americans’ health.

Maybe the Chicken Littles can take this off their clucking agenda.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, September 15, 2015

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