We’ve Been Here Before: History and Health Reform

Six times in the last century (most recently in the early 1990s), health reform has appeared on the national stage, only to be chased off by anxieties about state power, the promise of private alternatives, and the political clout of doctors and employers and insurers. The results are equally notorious: We spend nearly twice as much on health care as any other country. We insure a dwindling share of the population. And we routinely crowd the bottom of any international ranking of health outcomes.

Not surprisingly, given these familiar facts and changing of the guard in the nation’s capital, health care is once again at center stage. “From Maine to California, from business to labor, from Democrats to Republicans,” as Barack Obama waxed optimistically during the 2008 campaign, “the emergence of new and bold proposals from across the spectrum has effectively ended the debate over whether or not we should have universal health care in this country.”

Not so fast.  Despite assurances that this time things will be different—that the stakes have changed, that powerful interests are now on board, that Congress will be coddled into cooperation—there is a pall of familiar failure settling over the health care debate. The same sense of urgency and optimism accompanied past stabs at reform, all of which were spectacular failures. What lessons does this history offer?