JACOB HACKER: My name is Jacob Hacker, I’m a Professor of Political Science at Yale University.
BRIAN: I should tell you right now that Jacob Hacker, he’s not just any political scientist. This is the guy who, as a grad student 10 years ago, basically created the blueprint of this public option that we’ve been hearing so much about. So it’s clear where he stands in the legislative debate, but still, I thought it would be interesting to get his take on some of the history. So I put our caller’s question to him.
JACOB HACKER: Well, there’s a couple of answer to that question. The political scientist in me will say this is a reflection of our fragmented political institutions, and our anti-government political culture, that’s sort of one class of explanation.
BRIAN: Hold up, time out, Mr. Political Scientist. What do you mean by fragmented institutions. In radio talk, what is that?
JACOB HACKER: Well, in radio talk, it’s the checks and balances that our Constitution creates that make it so hard to pass integrated comprehensive programs.
BRIAN: So different branches of government.
JACOB HACKER: Different branches of government, federalism with the states and the federal government with overlapping responsibilities. There’s been scores of Europeans who have come over to the United States and sniffed at the American state, and said it doesn’t really constitute a state at all because it is so messy, and it is generally very hard to pass big legislative initiatives.
BRIAN: So that’s the political science view on all of this. It wasn’t simply doctors or drug companies who are opposed to reform. And it wasn’t just the big, bad insurance companies either. Hacker says that all those business interests would not have had the impact they had if it weren’t for our decentralized model of government.
JACOB HACKER: But I think it’s really important to understand that every time we’ve failed in the past to enact reform, a new set of vested interests has emerged, and just as important, we’ve seen the development of a massive system of private health insurance that covers the vast majority of working Americans. So to me that’s the big story, that the choices we made in the past have sent us down a path that’s very hard to get off of.
BRIAN: Health reform, on the national level, first went down for defeat in the Progressive Era, back in 1912. That was the year that Teddy Roosevelt ran unsuccessfully for a third term on a populist platform, that included compulsory sickness insurance, that would cover people’s wages while they were sick and out of work. The fight then moved to the state level, and reformers came close to winning in both New York and California. But this was just about the time that doctors were really beginning to feel their oats and organize, and medical care was getting more expensive. It didn’t take those doctors long to figure out that health care reform might directly affect their livelihoods. And then, there were these brand new insurance companies. Here’s Hacker again.
JACOB HACKER: Perhaps what’s an interesting story from this period is the story of Frederick Hoffman who worked for Prudential, who was an actuary. Actuaries are definitely a rabble-rousing bunch. In any case, he turned out to be one; he probably was the leading propagandist against any of these efforts. He said that there would be rationing of care; that government would come between patients and their doctors; he said that this was imported from Germany; that it was a Socialist plot. He said that it would be allowing immigrants to receive care; that it would be helping the less well-bred stock of the nation, and hurting the genetically pure. It was a panoply of fabrications and incendiary lies that bears, I’m sorry to say, a more than a passing resemblance to the some of the invective that has been hurled against health care reform this time around. I think it’s worth remembering: Every time we’ve had a debate over this issue, it has become a very emotional debate very quickly.
BRIAN: That highly charged history probably goes a long way towards explaining why Franklin Roosevelt decided to drop national health insurance from his New Deal legislation in the mid-30s. He had plenty on his plate already with social security and unemployment insurance, but still, it’s a decision that pains Jacob Hacker even today.
JACOB HACKER: He had a remarkable political position. He comes into office during the worst economic downturn in the Nation’s history; he has a mandate to act; he has huge democratic majorities. My read of the history, and a lot of other people’s read of the history, is that had Roosevelt had insisted on some kind of health insurance provision in the Social Security Act, it probably would have passed. And he didn’t for two reasons: one of which is the doctors were completely opposed . . .
BRIAN: . . . and we should just pause and say that these were pretty big men around town, they were pretty influential in local communities, congressional districts.
JACOB HACKER:. . . yes, they had all these state chapters and local chapters, and plus, whenever you went to your doctor, they would tell you whether or not it was a good or bad thing to have this happen.
BRIAN: And you know what else, we actually believed in experts in those days. We thought they were they were the good guys.
JACOB HACKER: You’re right. Why else would the tobacco companies have had the doctors touting Camel cigarettes, because if you’re doctor smokes, they must be good for you. In any case, the second thing is that Roosevelt believed that he could just come back and do this a few years later. And that was the first and the last in a sense time that putting it off was final.
BRIAN: Why was FDR our last chance, as you see it, up till now?
JACOB HACKER: I think FDR was our last chance because of the fact that when reform went down to defeat in 1935, or never even got a chance to be considered, that was really a turning point in the development of private insurance. It’s hard to remember today when people are losing coverage right and left, just how quickly health insurance expanded during and after WWII. Blue Cross plans, hospital plans, emerged in the midst of the Depression; and by the end of WWII, we’re talking about coverage that’s probably reaching about half of the American population, and so the typical blue-collar worker before WWII, didn’t have health insurance coverage; the typical blue-collar worker after WWII had pretty generous private health insurance. For that worker, suddenly the prospect of tax-funded national health insurance program is just a lot less attractive. So what I think is important to understand, is that it wasn’t just private insurance companies or drug companies or businesses that benefited from relying on private health insurance, at least initially, but also lots of Americans saw private health insurance as a good solution for them.
BRIAN: That’s Jacob Hacker, Political Science Professor at Yale University, and the original author of the so-called, Public Option Plan for Government Sponsored Health Insurance.