Alex Tallarida: RN, A Man Before His Time On Healthcare

During his second term, RN made expanding health coverage to all Americans a centerpiece of his domestic agenda.

“If the Government pays all the medical bills, then only the Government has a stake in holding down medical costs. This means that Government officials would have to approve hospital budgets and set fee schedules and take other steps that would eventually lead to the complete Federal domination of American medicine. I think this is the wrong road for America. It is the road that has been taken by so many countries abroad to their regret.” (Richard Nixon Radio Address November 3, 1972)

The Obama administration has taken on the issue of health care reform today in the United States, but this type of reform is not new. Richard Nixon had a significant role in healthcare during his presidency and if unimpeded could have helped prevent the current health care crisis in the United States. Specifically, in 1973, Nixon passed two important pieces of legislation that changed health care in the country. The Health Maintenance Organization Act of 1973 required employers with traditional health plans to also provide the option of choosing an HMO for its employees. The act also made it mandatory for employers to contribute as much to the HMO as they did to their regular plans. The Veterans Health Care Expansion Act of 1973 substantially expanded the health benefits available to our nation’s veterans and their families.

These two bills were only a piece of Nixon influence on health care during his presidency. Nixon’s most controversial and far reaching policy proposal was the Comprehensive Health Insurance Plan. This plan had seven key principles. First, it offered every American an opportunity to obtain a balanced, comprehensive range of health insurance benefits. Second, it would cost no American more than he can afford to pay. Third, it built on the strength and diversity of the existing public and private systems of health care financing and harmonized them into an overall system. Fourth, it used public funds only where needed and required no new federal taxes. Fifth, it would maintain freedom of choice by patients and ensure that doctors work for their patient, not for the federal government. Sixth, it encouraged more effective use of our health care resources. Seventh, it was organized so that all parties would have a direct stake in making the system work: consumer, provider, insurer, state governments and the federal government.

The most crucial part of Nixon’s plan was the employer mandate. Under this plan, every employer would be required to offer all full-time employees the Comprehensive Health Insurance Plan. Additional benefits could then be added by mutual agreement. The insurance plan would be jointly financed, with employers paying 65 percent of the premium for the first three years of the plan, and 75 percent thereafter. Employees would pay the balance of the premiums. Temporary federal subsidies would be used to ease the initial burden on employers who face significant cost increases.

In a unique moment of bi-partisan cooperation, in early 1974 Nixon’s political opponent in the Senate, Massachusetts Senator Ted Kennedy, agreed to a compromised deal of the Comprehensive Health Insurance Program and together they prepared to get the health care legislation passed through Congress. Unfortunately, the brewing Watergate scandal which soon took over the headlines, coupled with the subsequent lack of cooperation from Kennedy, prevented the President from pushing through with this initiative. With the President unable to continue to rally support, the efforts of labor unions, who hoped for a better deal under a new presidential administration, succeeded in derailing the Nixon-Kennedy health care bill.

If this bill were to have passed, would there be a health care crisis today? President Obama is currently facing criticism from some on the right of setting the stage for a socialist dictatorship under the appearance of health care reform. However, President Obama seems to be steering clear of a proposal for a mandate calling for all employers to provide health insurance, as was ventured by Nixon and Kennedy in 1974. Every employer, under Nixon’s plan, would have been required to offer all full-time employees the Comprehensive Health Insurance Plan. The rumor of Obama’s health insurance program is that it is a plan that would be modeled after the Medicare program that Americans are familiar with today. It would be available to those Americans who didn’t have good coverage from their employer. It would also be available to workers who worked in the smallest firms. And it would be made available through some kind of new insurance-purchasing exchange, through which people could get access to both private health insurance plans and this new public plan.

For his part, Nixon emphasized that his Comprehensive Health Insurance would not lead to an extreme program that would place the entire health care system under the dominion of social planners in Washington. Nixon wanted to continue to have doctors to work for their patients, not for the federal government. He believed that one of the most cherished goals of our democracy is to assure every American an equal opportunity to lead a full and productive life. Nixon saw his Comprehensive Health Insurance as an idea whose time had come in America. He saw a need to assure every American financial access to high quality health care.