As Senate and House powerbrokers meet this week to hammer out a conference committee compromise for the recently passed versions of the prescription drug benefit, the debate isn’t anything new or revolutionary. Congress has been talking about health care for more than half a century. But the voices have changed and the ideas have evolved over time.
“When President Johnson signed Medicare into law in 1965, he said in his speech: ‘No longer will older Americans be denied the healing miracle of modern medicine,’” Sen. Debbie Stabenow (D-Mich.) said last month in a Democratic radio address.
“But not once in his speech did he mention prescription drugs. Why? Because the modern medicines of today were just scientific daydreams back then,” she said.
To understand the origins of the prescription drug benefit, the larger national health care debate that started back in 1943 must be used as the first milemarker. Then-Rep. John Dingell (D-Mich.), the father of the current Detroit-area Democratic Congressman of the same name, co-sponsored the nation’s first comprehensive health care bill. Progressive health insurance benefits had been tossed around Capitol Hill since the days of President Theodore Roosevelt, but the Wagner-Murray-Dingell bill was Congress’ first attempt at creating a national health insurance program. But obstacles got in the way.
In 1945, President Franklin D. Roosevelt intended to push national health care but died before he was able to do so. For his successor, President Harry S. Truman, the Korean War shifted priorities elsewhere.
In 1955, the elder Dingell died and his son won the election to fill the seat, which he has held to this day. In honor of his father, the younger Dingell reintroduces his father’s 1943 bill each Congress as H.R. 16, numbered for the 16th district he and his father represented before redistricting changed the number.
During the Eisenhower administration, Republicans nixed any effort to create a national plan in favor of providing incentives for private insurers to improve coverage. But that too failed.
While the Dingell plan sat on the shelves, Sen. Robert Kerr (D-Okla.) and Rep. Wilber Mills (D-Ark.) managed to get support from the American Medical Association and Republicans for a measure that passed matching federal funds to states for the elderly poor in 1958.
But Dingell, Mills and others on the Hill continued to press for a more comprehensive program through the Kennedy and Johnson administrations. By 1964, a compromise was struck between the White House and Capitol Hill. Medicaid would extend health care coverage to the nation’s poor, and Medicare would assist the growing aging population. Both plans passed in 1965 and went into effect in 1966.
Just as discussions at both ends of Pennsylvania Avenue were gearing toward more reform during the Nixon administration, Watergate soon dominated the headlines. Measures pushed by President Richard Nixon and others by Mills and Sen. Edward Kennedy (D-Mass.) were put on the back burner as well. And then Mills’ infamous 1974 alcoholic bender turned Tidal Basin rendezvous with stripper Fanne Fox tarnished his reputation, and once again, the health care debate faded away.
Fast forward to 1991. Under unusual circumstances, health care suddenly became a political force as President George H.W. Bush was preparing for re-election. An unknown Democrat emerged to become a giant-slayer, using health care as his primary weapon in a special Senate election in Pennsylvania. Harris Wofford successfully dislodged the campaign of the popular former Republican governor and then-U.S. attorney general, Richard Thornburgh, coming from 40 points behind to win the special election.
The Pennsylvania Senate race caught most political watchers off guard, and soon the 1992 White House presidential hopefuls used universal health care as a rallying call.
“If George [H.W.] Bush continues to just stand there satisfied, he has every reason to be alarmed by the fire bell in the night from Pennsylvania. In this season of discontent, our wake-up call may give him the chance to save himself and reverse course,” Wofford said at the National Press Club after his Senate victory.
Bush would soon introduce a voluntary national health care system of his own before the 1992 election, trying to pre-empt a Democratic campaign flanking maneuver. But Bill Clinton and the Democrats, using a clear health care message — and still riding the waves from the Wofford Senate race — clinched the 1992 general election.
With the public’s attention still focused on health care, many Members — especially Democrats — thought the political conditions were right to push a universal health care plan.
“I think it is fair to say that there is now a growing consensus that we can and should and will enact health care reform this year,” said then-Sen. Donald Riegle (D-Mich.) at a January 1994 meeting of the Senate Finance subcommittee on health and the uninsured.
The Clinton health care plan — with then-first lady and now-Sen. Hillary Rodham Clinton (D-N.Y.) playing a central public role — made its way to the Hill that spring and to the House Energy and Commerce Committee chaired by Dingell.
While Dingell and many others wanted a more comprehensive plan, the White House proposal had the greatest chance of succeeding.
“I support the Clinton plan, and I have said so at every occasion. I have also said that as a practical legislator, it’s my job to work out something which can pass,” Dingell told National Public Radio in 1994.
Dingell, with the legacy of his father’s 1943 plan still with him, was charged with steering the Clinton plan through the Energy and Commerce panel. But he had to throw in the towel when Republicans — then in the minority — launched a massive public relations and legislative campaign to derail the Clinton plan. The votes didn’t come through in committee, and public support soon waned as suspicions of the highly complex nationalized health care proposal grew.
The wrecked plan was a signal of a Republican resurgence, and the 1994 GOP sweep of Capitol Hill obliterated any talk of universal health care into political background noise for the rest of the decade.
But another Democratic Senate hopeful, taking cues from the 1991 Wofford race, would unseat a Republican incumbent, reigniting the health care political tinderbox. Stabenow, then a Representative, used it as her key message and defeated Sen. Spence Abraham (R) in the 2000 elections.
But with Republicans dominating policy on the Hill and the 1994 universal health care defeat still in recent memory, any big-money comprehensive coverage plan was bound to end up in a legislative dustbin. So Stabenow had a tailored message.
The talk had shifted from universal coverage to plans of an augmented Medicare program with a prescription drug benefit. National health care policy discussions have been downsized, but they are still politically charged.
The recent debate in the House and Senate over the prescription drug benefit saw Members within the Democratic and Republican caucuses splitting over the plan. Many view the Republican leadership’s advocacy for the prescription drug benefit as a pre-emptive move to defuse a main Democratic issue before next year’s general election, not wanting another surprise Wofford or Stabenow to deal with in 2004.
On top of those political implications, others were hesitant to vote for the prescription drug bills because they felt they had many flaws.
“The only way to assure that the benefit will be available reliably and without complications to our seniors is to make it a guaranteed part of Medicare,” Sen. Carl Levin (D-Mich.) said in a June 26 floor speech. “The bill before us falls short of that. We should at least do no harm.”
Levin voted against the Senate bill, while Stabenow — his Great Lakes State Democratic colleague and prescription drug benefit champion — voted in favor of the plan, describing the Senate bill as a stepping stone to additional reforms.
Assuming that the prescription drug benefit makes it through conference committee and the president signs it into law — which is expected — the current debate will most likely quiet down until 2004 presidential and Congressional races heat up. But that is no guarantee that more changes are on the horizon because with health care reform, Members recognize that change has come only at a glacial pace during the past half-century.
“Obviously, it’s been a long road that has taken us to this day,” Sen. Olympia Snowe (R-Maine) told reporters June 27, after the early morning vote.