Robert Dallek: Obama Has Done What LBJ and FDR Couldn’t





[Robert Dallek is the author of books on FDR, Truman, Kennedy and Johnson. His new book, The Lost Peace: Leadership in a Time of Horror and Hope, 1945-1953, will be published in October.]

In June of last year, when President Obama invited nine historians, including myself, to the White House for dinner, the challenge of passing a national health insurance law, already the centrepiece of the President’s legislative agenda, was a topic of conversation.

After the President and Rahm Emanuel, his Chief of Staff, expressed concerns about the tough fight ahead, I asked if they knew about the healthcare advocate who had died and gone to Heaven. St Peter said to him: “You’ve led an exemplary life, you are entitled to an audience with the Lord.”

The Lord asked: “Do you have any questions?”

“Yes,” the man replied. “Will we ever see national health insurance in the United States? We thought we had a chance with Theodore Roosevelt, with FDR, Harry Truman, John Kennedy, Lyndon Johnson, Richard Nixon, and Bill Clinton. Will it ever happen?”

The Lord thought for a moment and said: “Yes, but not in my lifetime.”

The President and Mr Emanuel laughed, but they were less than amused. They knew that they had a difficult, if not insurmountable, challenge to overcome. After all, the battle over government-sponsored health insurance had been going on for 100 years; it had been an unrealised dream of reformers, who had come to understand that it represented a substantive and symbolic threat to the country’s devotion to rugged individualism and anti-statism.

When Franklin Roosevelt won the introduction of social security in 1935, he resisted including a provision for guarantees of health coverage for seniors; it impressed him as so controversial that it threatened to kill a commitment to guaranteed government pensions for the elderly. When Lyndon Johnson won congressional approval for Medicare in 1965, he dared not include more than retired people or men and women over 65. Moreover, he was inclined to ask only for a programme covering seniors’ hospital bills, fearing that any proposal to include doctors’ fees would further agitate opposition.

Only when conservative opponents proposed Bills with hospital and doctors’ payments through subsidies to private insurance companies rather than via a government programme did Johnson add these costs to his Bill. Although Roosevelt and Johnson won their reforms with bipartisan backing, they had to fight hard against fears that citizens would become dependent on government largesse.

Does Mr Obama’s healthcare reform law represent as great a change in America’s social arrangements as social security and Medicare?

Without question. As is evident from the fierce opposition the measure provoked (socialism, communism, fascism, Nazism were some of the descriptions levelled by opponents), the law will eventually have a great impact on the lives of 32 million citizens and is likely to open the way to something akin to a National Health Service once the current legislation establishes itself as a popular part of the social safety net.

In time, the Obama law is likely to become as invulnerable to conservative reversal as so many other New Deal and Great Society reforms of the past 80 years. No one should assume, however, that the 100-year war over national health insurance is at an end. Fears that the law is the thin end of a wedge leading to an NHS is alone enough to sustain the debate...



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