The latest buzz on President Obama's health care plan is that the White House is in uber-pragmatic mode. Their favorite cliche is that we shouldn't let the perfect be the enemy of the good. Something, we're told, is better than nothing.
Well, maybe not -- at least that shouldn't be the administration's negotiating position going in. Here, the New Deal experience on health care might be instructive.
In 1933, Franklin Roosevelt told his labor secretary, Frances Perkins, that he believed in "cradle to grave coverage" under a public insurance model. But he asked Perkins to wait a couple of years before he introduced Social Security. First, he wanted Perkins to build support for it by traveling around the country.
That turned out to be a sensible strategy. Even though the original 1935 Social Security Act displeased a lot of New Dealers because it didn't cover farmers or domestic servants (essentially excluding blacks), it was a start -- and about the best that could make it through Congress at the time.
But on health care, FDR punted. We don't know why, but I have my suspicions. The Roosevelts' first-born son, James, was married at the time to the former Betsey Cushing, one of the legendary Cushing sisters of Boston, famous for their beauty and class (Betsey was later married to Jock Whitney and her sister, Babe, married William Paley). Their father was Harvey Cushing, arguably the most eminent doctor in the United States. Cushing had invented many surgical techniques and enjoyed wide respect.
Like other doctors, he loathed the idea of national health insurance. One day he went to the White House to dine alone with President Roosevelt and that was the last anyone heard of health care being included in Social Security. Harry Truman tried it in 1948 and got beat by the AMA. LBJ had partial success with Medicare but Nixon, Carter and Clinton were all stymied.
A big reform this year is likely, but a half- or quarter-loaf won't cut it. If Congress rejects a public option--the only real way to control costs--and Obama goes along, a great moment will have been lost. Moving toward universal coverage and ending discrimination against those with preexisting conditions are important, but they will expand costs, not restrict them. "Comparative effectiveness" studies and electronic records are no panacea, as Yale's Theodore Marmor has shown.
Read the rest of the piece on Alter's blog 'Between the Lines' on Newsweek.com.