Newswise — As the health care reform debate continues to rage, the federal government’s role in health care has served as a contentious hot-button topic for at least 150 years, according to Texas Tech University’s director of the Social Work Program.
Helen Morrow, an assistant professor of social work, said that while Americans accepted the need for public health institutions as far back as the late-1700s, many ideas or movements to involve the federal government met with stiff opposition in the 19th and 20th centuries.
Morrow said that when federal government did involve itself in public health, usually it came about as a reaction to critical health situations.
Sick merchant seamen received the benefit of the first public health law in 1798 with the Marine Hospital Service, she said. Later, disease-laden Civil War encampments that killed twice the number of servicemen as combat prompted President Lincoln in 1861 to sign into law the United States Sanitary Commission.
Congress established a National Health Board in 1879, but let it expire in 1883, she said. The original Marine Hospital Service did not become today’s Public Health Service until 1912.
“Before 1850, most public health activities, such as quarantines and sanitary measures, were in reaction to epidemics,” Morrow said. “The national public health movement that followed in the late-19th and early-20th centuries met resistance for a couple of reasons. The cities and states did not want any of their powers to regulate or to tax health care taken away by the federal government, and physicians were fearful of public health encroachment on their private practices.
“Some blame the delay on the resistance of states and cities to a federal takeover,” she said. “There may have been other factors, but this resistance was certainly among them.”
Medicare, a federally subsidized health insurance program for the elderly and some disabled people, also met with resistance, Morrow said. It was debated long before it was enacted. President Roosevelt wanted it in the 1930s, but his advisors told him that Social Security wouldn’t pass if he tried to tack on medical benefits. The problem again was fear that the federal government was interfering too much with health care.
“Given the heat of the current debate, I suspect his advisors were correct,” she said.
Medicare and Medicaid wouldn’t pass until 1965.
During the Clinton Administration’s 1997 health care reform attempt, those in favor of reform couldn’t get their act together, she said. By the time Clinton’s proposal was finally on the table, too few people were truly supportive.
“Those who opposed reform did not have to agree on the details; they only had to say ‘no,’ ” she said. “Does this sound familiar?”
People who believe in the domino theory will be inclined to see “socialized medicine” as inevitable if we have a public option, she said. On the other hand, if the populace-at-large truly wants to continue private health insurance coverage, it will make sure that the necessary incentives are in place to continue this part of the status quo in the same way that public schools have not caused private schools to close.
“Regardless of the outcome of this year’s debate, we Americans are still stuck with the same questions,” Morrow said. “Is heath care a right or a privilege? And to what extent are we willing to ensure that everyone has access? Perhaps, instead of debating the likelihood of a government takeover of health care, we should debate and discuss our values on health care – not our fears – to guide our future health care plans.”
If you are a reporter on deadline and have trouble reaching Morrow, please contact John Davis for alternative contact information.
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