Although Americans love anniversaries, we have overlooked the political importance of July 10, 1969. Speaking on that date from the Roosevelt Room of the White House, President Richard Nixon became the first president to declare that America faced a “massive crisis” in health care in the absence of “revolutionary change.”
Similar predictions of impending catastrophe have, incredibly, persisted through each presidency for a half-century. The Trump administration, for example, has warned that “the system we have is unsustainable and it cannot continue.” Given the latest Wall Street Journal/NBC News poll, in which respondents picked health care as the top priority for the federal government, as well as the evidence from the first two Democratic presidential candidate debates, this election season will surely bring more of the same.
But have Americans really spent a half-century hopelessly hankering for reform? While the cry of “crisis” may be constant, the real story is more complex and, in these partisan times, more encouraging.
The conventional liberals-versus-conservatives reform narrative distorts history. Take, for instance, the hearings on the “health care crisis in America” convened by Sen. Edward Kennedy (D-Mass.) in 1971. “The question,” declared Kennedy in what would become a timeless refrain, “is no longer whether there should be reform, but what the reform should be.”
While those hearings did signal a new round in the Hundred Years’ War over universal health insurance — a continuing conflict highlighted by the present political battle over “Medicare for All” — focusing on the insurance stalemate shortchanges how policymakers have addressed other pressing problems.
For instance, one part of the crisis cited by both Nixon and Kennedy was a severe physician shortage. Americans’ demand for medical care had surged following the passage of Medicare and Medicaid and the growth in employer-sponsored health coverage. Targeted legislation not only solved that problem, it eventually helped produce what some subsequently labeled as a physician surplus.
Moreover, in the first years of Medicare, overbilling was rampant for often-questionable care: One doctor charged $58,000 for a day’s house calls. And a 1974 House investigation found that 2.4 million unnecessary surgeries were performed each year. Again, these abuses were radically reduced by legislation authorizing the kind of oversight we now take for granted.
As third parties paid more of the medical bills in the 1980s, spiraling costs threatened government and employer economic stability to a serious degree often forgotten today. This genuine crisis spurred changes in payment that largely remain in place and laid the foundation for today’s value-based payment schemes.
But in the 1990s, when even more stringent cost controls spawned patient horror stories about care rationing, Congress cracked down on health plans’ perceived penny-pinching. Putting aside political disagreements, the Senate unanimously passed the Clinton administration’s Newborns’ and Mothers’ Health Protection Act, mandating minimum hospital stays for women who had given birth, while the House gave it an overwhelming 388-25 vote.
With the exception of the Affordable Care Act, reform has been doled out as patchwork fixes. Also with the exception of the ACA, those fixes have mostly been bipartisan. Despite resistance by “powerful and parochial interests,” as Kennedy put it in 1971, or “the tangled web of special interests,” as President Trump phrased it recently, evolutionary change has been effective, even if frequently frustrating.
To make one thing perfectly clear (a phrase Nixon favored), I’m far from a Pollyanna. I’ve written critically for years about the human and financial toll taken by persistent and fixable quality and safety problems in American medicine. But chronic pain, even if serious, is not the same as an imminent threat to survival.
Health care inflation, long supercharged, has since 2010 simply kept pace with general economic growth. Gallup senior scientist Frank Newport noted recently that that there’s little sense among the general public that the U.S. health care system as a whole is “untenable or on the verge of collapse.”
The public is right — and politicians, pundits, and health care pontificators would do well to listen. On the 50th anniversary of the perpetual health care “crisis,” it’s time to chuck the Chicken Little rhetoric.
The sky is not falling. Rather than aim for “phenomenal” health care, as President Trump recently promised to produce, the administration and Congress should focus on a bipartisan approach to fixing the surprise medical bills, sky-high drug prices, and other health care system ills that are causing such pain to so many Americans today.
Michael L. Millenson is the president of Health Quality Advisors LLC and the author of “Demanding Medical Excellence: Doctors and Accountability in the Information Age” (University of Chicago Press).