In 1935, President Franklin D. Roosevelt was mulling over whether or not to incorporate a national health insurance program into his New Deal.
Fearing it would jeopardize the chances of Congress passing his other New Deal initiatives, Roosevelt decided to leave it out.
Since then, however, national health insurance has been a main priority for many Democrats.
Proposals have come and gone, starting with President Harry Truman’s in 1947. Most recently, the Clinton administration made strides toward a national health insurance plan in 1993 but fell short of its goal.
With the inauguration of President Obama, the wheels are again beginning to turn towards establishing a comprehensive health care system.
According to Larry Schwab, a professor of political science at John Carroll University, Obama will likely let Congress take the lead on any proposal.
“[Obama] is not going to propose a specific plan, but rather broad principles, and he will work off what the Democrats are doing in [congressional] committees,” said Schwab.
The majority of Americans receive their health insurance through their employers. Obama has signaled that he favors a plan that would allow those who are happy with their private insurance to keep it, and to simply incorporate a few “tweaks” to the current system to cover the roughly 45 million uninsured Americans.
According to Schwab, some of the tweaks that Obama has considered and which will be debated on by Congress include whether to incorporate a mandate on individuals to purchase insurance and a mandate on businesses to provide insurance to their employees.
They will also have to decide whether any of the public health insurance programs, such as Medicare – which covers the elderly and disabled – and Medicaid – which covers the poor – should be expanded.
One of the most controversial issues has been whether to establish a public health insurance plan that would compete with private insurance plans.
Democrats, who support this measure, believe it would stimulate competition in the private market, for health insurance, which would help to keep costs low.
Republicans, however, argue that private insurers wouldn’t be able to compete with a public plan, which would crowd out private plans and eventually result in a completely public health insurance system similar to those used by many European countries.
Another important concern of any plan would be containing costs. In 2008, health care spending in the United States was a record $2.4 trillion, and is projected to reach $3.1 trillion a year by 2012.
Even though the United States spends more on health care per capita than any other industrialized nation, many of those countries are still able to provide national insurance, and their populations also have longer life spans and better infant mortality rates than the United States.
There has already been movement toward establishing electronic medical records, which appeared in the economic recovery package passed earlier this year.
Obama has recently said that he may consider taxing employer-sponsored health insurance, which may also help to control costs.
Schwab also said that there will be a move toward a cost containment board, which will analyze health care in the United States and attempt to make it more efficient.
Lately, discussion has also arisen among the Democratic leadership in both the House and Senate over the use of a special parliamentary procedure called budget reconciliation.
Budget reconciliation is the process in which the rules of Congress would be suspended in order to expedite passing a budget.
Usually, this measure is used if Congress wishes to alter tax policy or make alterations to entitlement programs such as Social Security and Medicare.
Democrats claim that it would be fair to include health care policy in a budget reconciliation process citing Republican use of this procedure when passing President Bush’s tax cuts in 2001. Republicans, however, disagree with this assessment, claiming that health care policy is outside the realm of intended uses of reconciliation.
Whether or not this process will be used will be a critical factor, said Schwab, because it would eliminate the Republicans’ ability to filibuster in the Senate.
According to Schwab, one of the best defenses against criticism would be selling the program to the American people properly.
“This is one of the lessons from the 1992-93 proposal, where the primary focus was insuring the uninsured,” Schwab said. “The best way to sell it is to make cost containment the first priority.”
This strategy would put the focus of any health insurance plan on middle-class Americans rather than the poor, which may be more appealing politically.
While Democrats in Congress and Obama are preparing their plans, there is an opposition growing among Republicans, who claim that such a policy is a “slippery slope” toward socialized medicine.
However, it appears as if the public is behind a comprehensive health care plan.
“For decades, generally the polls have favored Democrats over Republicans [on health care policy] and would rather go toward a government side plan as opposed to a the market side [approach],” said Schwab.