Fluid ImaginationA careful study of the text and history of Section 3 [of the 14th Amendment] shows clearly that the provision was designed to protect American democracy against exactly the kind of threat that Donald Trump represents. The justices have therefore been faced with the decision of either following the Fourteenth Amendment’s command and accepting the momentous consequence, or concocting some sort of escape route.
— “The Hot Potato of Trump’s Disqualification,” The Atlantic
From We Can Be Framers Too:
[T]he Constitution is too fundamentally antidemocratic a document to serve democratic purposes reliably. If we want to make it genuinely and lastingly democratic, we will first have to consider changing it in the most basic way: by amending Article V, which governs amendments and so serves as the gatekeeper for living generations to say what they—we—believe American fundamental law should be. This would be a way of empowering ourselves to become founders, over and over, and not just inheritors.
From Alito’s Plan to Repeal Roe—and Other 20th Century Civil Rights:
A movement will eventually emerge to oppose the criminalization of abortion and the despotisms this draft would create, and perhaps some of its leaders are alive today. Whoever they are, they will understand, just as the right-wing activists who worked decades for this moment do, that the freedoms enjoyed by one generation can be stripped away by another.
From The Framers Would Have Wanted Us to Change the Constitution:
Some believe that we should refrain from tampering with the Framers’ handiwork. Others suggest that amending the Constitution is impossible or think it wiser to spend political capital and resources on more attainable goals. None of these responses is new. Throughout history, advocates of an unworkable status quo employed the language of constitutional idolatry and pessimism to oppose sorely needed change.
In his State of the Union address in 1944, President Roosevelt suggested a second, economic-based Bill of Rights because his generation, which was still in the middle of World War II, came “to a clear realization…that true individual freedom cannot exist without economic security and independence [and that] people who are hungry and out of a job are the stuff of which dictatorships are made.”
Among other rights, President Roosevelt’s address proposed for every American citizen “a right to adequate medical care and the opportunity to achieve and enjoy good health.”
President Roosevelt wasn’t the first to call for an American right to healthcare.
His fifth-cousin, former President Theodore Roosevelt, made affordable health insurance a key plank in the agenda of his Progressive Party. In his Confession of Faith speech from 1912, given four years after his second term ended, former President Roosevelt called for “industries, the employer, the employee, and perhaps the people at large to contribute” to the insurance pool. Though Roosevelt did not call for the recognition of a new American right, he did recognize the unfairness “for any industry to throw back upon the community the human wreckage due to its wear and tear.”
In 1915, the American Association for Labor Legislation called for subsidized healthcare for low-income workers, but opposition from the American Medical Association and a little thing called World War I prevented it from making much headway (opponents at the time characterized the proposal as “a Prussian menace”).
In the 1930s, President Roosevelt’s Committee on Economic Security considered adding government-funded healthcare to the New Deal, but the American Medical Association’s opposition prevented it from being included in the Social Security Act of 1935. Despite the opposition, President Roosevelt continued to stump for the policy, as did his Surgeon General, who argued “equal opportunity for health is a basic American right.”
At the end of the 1930s, a New York Senator proposed the National Health Care Act of 1939, which “created federal funding to states for expanding public health, maternal and child health services, medical care for the low-income, short-term disability insurance, hospital construction, and prepaid medical insurance,” but the onset of World War II distracted Congress from ever taking it up.
In the 1940s and 50s, various versions of the Wagner-Murray-Dingell Bill proposed compulsory health insurance for every American, paid for through payroll taxes. After President Roosevelt died in office without Congress having taken up his call, his successor, President Harry Truman, came out in support of the bill, but with anti-socialist Republicans in control of Congress, the proposals died before they got a chance to breathe.
Congress wouldn’t seriously address healthcare for another two decades, when President Lyndon Johnson signed the Social Security Amendments of 1965 to create the Medicare program, which aimed “to provide a hospital insurance program for the aged…with a supplementary medical benefits program and an extended program of medical assistance.” With this bill, President Johnson and the 89th Congress created a universal health insurance program for every American over the age of 65.
President Richard Nixon tried to reduce government involvement, proposing a Comprehensive Health Insurance Plan that would force employers to carry the burden of health insurance for most Americans, while also providing assistance to low-income individuals and improving Medicare. Unfortunately, President Nixon’s crimes in the Watergate scandal put an end to his legislative agenda.
His elected successor, President Jimmy Carter, abandoned his earlier call for mandatory, universal coverage, disappointing his ally, Senator Ted Kennedy. Instead of trying to expand coverage, President Carter fixated on reducing the cost of healthcare as part of his focus on reducing inflation. He later wrote that “for most of my term, I fought the hospital and medical lobbyists, trying to initiate hospital-cost containment measures designed to insure adequate health care at a reasonable expense…I was never able to succeed in this effort…In the final showdown, Congress was flooded with money, in the form of campaign contributions from the health industry.”
President Ronald Reagan took a different route on healthcare. He’d long been an opponent to federally-funded healthcare. In 1961, he released a 10-minute long speech on LP titled, “Ronald Reagan Speaks Out Against Socialized Medicine,” which (of course) was secretly paid for by the American Medical Association. Twenty years later, the AMA’s spokesperson became president, and the Reagan Administration slashed federal funding for healthcare. His budgets cut Medicaid funding by 18%, reduced the budget of the Department of Health and Human Services by 25% (eliminating a number of healthcare programs in the process), and cut funding for maternal and children’s health by 18%.
The hits continued. Under the Reagan and George H.W. Bush administrations, “a million children lost reduced-price school lunches, 600,000 people lost Medicaid, and a million lost food stamps…Nearly 500,000 lost eligibility for Aid to Families with Dependent Children…More than 250 community health centers were closed. Between 1980 and 1991, 309 rural hospitals and 294 urban hospitals were shuttered. Nearly one million Native Americans lost access to Indian Health Service care when eligibility was narrowed…Unintended pregnancy rates increased by nearly 8 percent…Life-expectancy-at-birth of black Americans decreased…By 1988, the Institute of Medicine declared that the American public health system had fallen into disarray.”
President George H.W. Bush didn’t care about healthcare. According to what his staff members told a healthcare writer, the president was “bored silly” by domestic policies and his healthcare proposals in the election of 1992 were only offered as a sop to voters — “he was a fish out of water on health care from start to finish.”
After defeating the incumbent (partly due to the healthcare issue), President Bill Clinton made universal healthcare the number one priority of his administration, and in an unprecedented step, he appointed his wife, then First Lady Hillary Clinton, to oversee a task force to make it happen. The result was a 1,000+ page proposal called the Health Security Act, which wasn’t universal healthcare, but was a suite of complex health insurance plans aimed at providing a comprehensive benefits package to all citizens, permanent aliens, and long-term nonimmigrants (e.g., foreign diplomats). Famously, the Clinton effort failed.
President George W. Bush reversed some of the Reagan-era reductions in healthcare-related federal spending. He took strong steps to curtail HIV/AIDS on a global scale. His administration’s Emergency Plan for AIDS Relief was “the largest commitment by any nation to combat a single disease in human history.” His administration also took on diseases such as malaria and tuberculosis around the world.
For Americans, he expanded prescription drug benefits under Medicare, giving the program its largest expansion in decades (though denying the program the right to negotiate en bloc). According to an editorial in The New York Times published in the days before he left office, the plan was responsible for “reducing the percentage of older Americans who lack drug coverage, from 33% before the program started to only 8% in 2006.” He also doubled federal financing of community health centers.
But he focused less on ensuring the right of all Americans to quality healthcare and more on expanding the market’s influence on the industry. In 2003, Congress created Health Savings Accounts, high-deductible health plans that allow for tax-preferred treatment of medical expenses. HSAs were, as one of his advisors put it, “an opportunity for people…to have more skin in the game,” but as one of his critics, Senator Ted Kennedy, said, “President Bush’s health savings accounts are a gimmick that will only make a bad situation worse.”
When President Barack Obama took over the White House in 2009, he followed President Clinton’s lead and made healthcare his first priority. After a bitter fight in Congress over what would be termed Obamacare, he signed the Affordable Care Act (ACA) into law. While the progressive goal of single-payer healthcare was abandoned during the drafting of the bill, President Obama tried to sidestep the failure by suggesting with its passage, “we finally declared that in America, health care is not a privilege for a few, but a right for all.”
Of course, we didn’t do that. Instead, with the passage of the ACA, which forces Americans to either buy health insurance or pay a penalty during tax season, we declared that the United States is committed to a private health-insurance industry regardless of the profit motive’s effects on the health of our citizens.
Despite saying his healthcare plan was perennially two-weeks away from being submitted to Congress, President Donald Trump failed to replace the Affordable Care Act with a federal plan of his own. While he did succeed in gutting the personal penalty from the ACA (reducing it to $0) and repealing “the Cadillac tax” on high-end plans, at the end of a hell-scape of an administration that saw the death of over 400,000 Americans due to a global pandemic, the ACA remains the law of the land.
We’re now less than three weeks into the administration of President Joe Biden, and every one of those days has seen over 2,500 Americans die from the pandemic. While it’s way too early to know what the Biden Administration will deliver for Americans, his campaign promised to “build on the Affordable Care Act by giving Americans more choice, reducing health care costs, and making our health care system less complex to navigate.”
President Biden’s commitment to the ACA will ensure that Americans will continue to suffer from a lack of universal, single-payer coverage for at least the next four years. During the campaign, President Biden doubled down on his opposition to “Medicare for All,” saying that if he was president when Senator Bernie Sanders’ bill reached the White House, he would veto a “single-payer, national health insurance program to provide everyone in America with comprehensive health care coverage, free at the point of service.”
The American history of universal healthcare is long and complex, and many of the arguments focus on the technical difficulties of trying to provide quality, affordable care to a nation of roughly 300 million people without driving the nation or its people into perpetual debt.
But all of the focus on how to make it happens obfuscates the why. As a nation, we still have not fulfilled President Franklin Roosevelt’s promise; we still do not recognize that healthcare is a human right.
Until we take that first step, all the discussions about how universal healthcare will work or who it will work for or how it will be paid for are useless. They all assume that we have a choice, when the reality is that, if healthcare is a human right, we don’t. We just have to make it work
We don’t need a 1,000+ page document to make universal healthcare the law of the land. All we need is a single sentence enshrined in an amendment to the U.S. Constitution that declares healthcare is the right of every citizen.
We already have some decent options on how to formulate that right:
Regardless of its wording, once the right has been established, we’ll have changed the entire environment in which healthcare is delivered in this country. The federal government, doctors, nurses, medical schools, hospitals, community health centers, private insurance companies, all of them will have to adapt to the new reality. That process will continue to be long and complex, but they won’t have the choice of maintaining the status quo.
If we change the conditions around which they try to solve their problems, perhaps we’ll make it possible to actually solve those problems.
The way forward is not to get stuck in the muck of how to do universal healthcare (which, by the way, every other developed country has already figured out), but to enshrine the why in our U.S. Constitution.
From The Case for Consequences
A democracy is not only a collection of laws, and norms of behavior by political elites. It is a set of beliefs by the people. The conviction that crime pays, and that the law is a weapon of the powerful, is a poison endemic to states that have struggled to establish or to maintain democracies.